bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psychodynamic Psychiatry Education and Training for Health Care Staff in the Acute Hospital Setting
Authors: Bo Lorna , FitzGerald James , Arends Fraser , Peters Pamela 
Published: July 2023

AimsPsychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that healthcare staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for healthcare staff in the Cambridge University Hospitals (CUH) NHS Foundation Trust, and to evaluate the perceived benefits of attending in terms of personal and professional development.MethodsConvenience sampling was used to recruit CUH doctors, nurses, and healthcare assistants at all stages of training as part of their in-house teaching schedule. Sessions were delivered via an online format or in person. The evaluation period was between October 2021 and July 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessionsResultsThirty-three participants responded to our survey, with the sample consisting of gastroenterology (n = 4), acute medicine (n = 6), and emergency medicine doctors (n = 10). The sample also included emergency department nurses (n = 8) and health care assistants (n = 5). included. Most respondents (>90%) described the experience of the sessions including the material covered as ‘Positive’ or ‘Very Positive’. All participants felt they were able to express themselves in the session and the majority (>97%) felt that the sessions were relevant to their training needs and focused on the right issues. Notably, most participants (>88%) felt the sessions enhanced their ability to recognise the importance of the therapeutic relationship, the emotional significance of symptoms as well as the impact of group dynamics on patient's presentations.ConclusionOur findings suggest that these psychodynamic psychiatry training seminars provide an effective, safe, non-judgemental space for experimentation and interdisciplinary discussion to support healthcare staff management of complex patients. Our results support the expansion of this low-cost, high-value intervention for both the well-being and professional development of healthcare staff.
Targeted Approach to Providing Child and Adolescent Mental Health Education to GPs
Authors: Foster Michael , Sherratt Anna , Hawcroft Victoria , Maqsood Hamid 
Published: July 2023

AimsThe aim of this project was to construct and deliver an educational session for general practitioners (GPs) in local Primary Care Networks on challenging child and adolescent mental health conditions. It was hypothesized that delivering targeted teaching sessions, supported by the same quiz applied before and after, would demonstrate an effective and repeatable method of improving GPs’ knowledge about these conditions. Since the COVID-19 pandemic, demand on both Child and Adolescent Mental Health Services (CAMHS) and GPs has reached unprecedented levels. Compounding this load, half of all referrals written by GPs to CAMHS are rejected, which prolongs the time a young person is under GP care, delaying specialist intervention. Unfortunately, during GP training exposure to CAMHS is limited and dedicated teaching is often insufficient. As a step towards addressing this challenge, a comprehensive teaching session combining didactic and socratic methods was devised and tested.MethodsThe teaching session comprised the presentation, diagnosis, and first steps in management of four challenging conditions in children: autism, eating disorders, depression, and emotional dysregulation. A quiz with multiple-choice answers was administered before and after the presentation, addressing each of the four conditions. The data collection took place between December 2022 and January 2023. A total of 29 pairs of quizzes were completed by GPs. Due to the type and size of data collected, a non-parametric bootstrap resampling method was used to compare the before-and-after scores for each topic and overall score.ResultsFor the 29 pairs of quizzes, mean differences and 95% confidence intervals (CIs) were calculated between before-and-after scores, for each topic and for the total. All 4 topics showed statistically significant mean improvements: autism 1.3 CI: [0.9 , 1.8 ], eating disorder 1.8 CI: [1.4 , 2.3 ], depression 1.4 CI: [1.0 , 1.7 ] and emotional dysregulation 1.7 CI: [1.4 , 2.0 ]. The total mean improvement was 6.2 CI: [5.5 , 6.8 ] out of a maximum 16 points.ConclusionThese targeted educational sessions suggest it is possible to make reliable improvements in GP knowledge across a variety of topics. With child and adolescent mental health demands at record levels, a more focused approach of the kind considered here may offer a model for training elsewhere. As an indication of the impact of this approach, further sessions on other topics have been requested by the GP teaching leads.
Gogledd Cymru-Peer Supervision in Psychotherapy (GC-PSP): What Are Lessons Learned After Two Years?
Authors: Loo Jiann Lin , Simiyon Manjula , Sambhi Rajvinder Singh 
Published: July 2023

AimsCore trainees in psychiatry (CT) must attain competencies in at least two psychotherapy modalities before they are allowed to sit for the final Royal College of Psychiatrists’ membership exam. The common training approaches in the United Kingdom include regional training workshops, weekly Balint groups, and access to individual supervision. Some CTs express their wish to have extra opportunities to practice psychotherapeutic skills and discuss cases in order to enrich their experience in learning psychotherapy. Therefore, the peer-led GC-PSP, i.e. Gogledd-Cymru (North Wales) Peer Supervision in Psychotherapy is conceptualised as a quality improvement project (QIP) for North Wales CTs. This article aims to illustrate the lessons learned after two years of GC-PSP.MethodsA baseline survey was done to identify trainees’ ideas, concerns, and expectations in psychotherapy training and weekly one-hour supervision sessions were set up in May 2021. Sessions were facilitated by a speciality trainee (ST) in psychiatry with experience in psychotherapy. The agenda was determined on the day based on the specific issue or expectation brought up by trainees which could include: clarification of psychotherapeutic concepts and knowledge learned elsewhere, skill training through role-playing, case formulation of clinical encounters, discussions on suitable intervention, and any topics that were relevant to psychotherapy or combination. Subsequent written and verbal feedback was gathered.ResultsA total of 48 sessions had been conducted in two years, with 37.5% covering knowledge teaching, 45.83% skills training, and 39.58% case-based discussions. The top five modalities requested by CTs included: cognitive behavioural therapy (32.35%), psychodynamic therapy (20.59%) acceptance and commitment therapy (17.65%), motivational interview (11.76%), and behavioural activation (8.82%). The overall attendance had been inconsistent, ranging from no attendees and the highest of eight attendees comprising medical students, foundation year trainees, core psychiatry trainees, general practitioner specialist trainees, and specialist registrars.ConclusionAlthough inconsistent attendance results in the repetition of discussions and topics, all trainees feel the extra sessions support their learning in psychotherapy in a safe space as they feel the small group discussion allows more active participation and they are able to learn from others on top of their individual supervision (positive Kirkpatrick level 1 reaction). All trainees wish to have this initiative continued and prefer a semi-structured rather than totally flexible agenda so that they can plan for their attendance, which can be a consideration for future implementation.
Mentorship Scheme at Surrey & Borders NHS Foundation Trust
Authors: Majid Zafrina , Cremin Patrick , Mudunkotuwe Jeremy 
Published: July 2023

AimsTo establish a mentorship programme for all grade of Psychiatrists working within Surrey and Borders Partnership Trust.MethodsRSPsych guidance was used to establish a mentoring programme within Surrey and Borders Partnership Trust.A core leadership team was identified and established, this included the Director of Medical Education, a Higher Specialist Trainee, and a Core Trainee.The decision was made to structure the programme to involve all grades of doctor within the trust, with pairing of Mentor and Mentees tailored to mentee needs. Support from the core team will also be offered to both Mentees and Mentors on a regular and drop in basis, as well as support groups for each group.The programme was then advertised using a trust email list and training days were held via Microsoft Teams and delivered by the West Midland Mentoring Team RCPsych.The programme is due to launch in February 2023 with expected widespread engagement, followed by evaluation survey.ResultsWe received a good response from all grades of doctors targeted in the Mentorship Scheme.Following this a prelaunch meeting, facilitated by the core leadership team, was organised for all those involved in the scheme.This meeting outlined the aims of the scheme and support available to both Mentors and Mentees.The Mentors and Mentees have now been paired and the scheme will be launching in February 2023.ConclusionBurnout is a significant and highly prevalent phenomenon within the Psychiatric community.Mentorship is shown to reduce rates of burnout as well as improving staff well-being, productivity and retention.Following RCPsych guidance this project aims to establish a mentorship programme for all psychiatrists within the Surrey and Borders NHS Trust.The Surrey & Borders Mentorship Scheme will launch in February 2023.
Supporting Well-being and Resilience: Delivering Interactive Workshops for Psychiatry Core Trainees
Authors: Ruddock Kenneth , Neil Catriona , Galloway Suzanne , Hegde Rekha 
Published: July 2023

AimsStress and burnout is increasingly recognised as an issue for doctors in training. The 2022 General Medical Council (GMC) National Training Survey revealed that 39% of respondents were suffering from burnout to a ‘high’ or ‘very high’ degree. 51% felt their work is emotionally exhausting. There are multiple sources of stress for psychiatry trainees, including clinical demands, adverse events, the impact of emotional labour and moral injury. The Royal College of Psychiatrists recognises the importance of supporting trainees’ well-being; this has been reflected with the inclusion of personal well-being-focussed key capabilities in the new Core Psychiatry Training curriculum.MethodsTo meet these needs, we developed and delivered two interactive face-to-face workshops for Year 1 Core Psychiatry Trainees (CT1s) in the West of Scotland. Training is embedded within the CT1 educational programme and facilitated by higher trainees. The sessions cover key aspects of well-being, including the physiology of stress, risk factors for burnout and the evidence base for developing resilience. We explore the impact of errors on doctors and the health service, relevant clinical governance systems and regulatory policies, focussing on psychiatry training issues. Feedback was obtained immediately after each session via anonymous questionnaire with a mixture of Likert scale and free text responses.ResultsThere were 27 responses for workshop one and 21 for workshop two. 14 respondents felt the teaching should be mandatory for core training. There was mixed opinion regarding the overall benefit and optimum timing of the sessions within the training year. Overall, CT1s valued group discussions and wanted more time for this with less focus on GMC policy. There was also split opinion on the value of discussing institutional responses to errors, including significant adverse event reviews and Datix reporting.ConclusionOur feedback showed differing opinions on which topics should be covered during the training and their level of detail. Overall, the opportunity for group discussion – in order to share experiences with peers – appeared to be valued most. We feel the sessions provide new CT1s with an opportunity to explore problems they may encounter in a safe and supportive environment.We aim to provide trainees with a ‘toolkit’ to support their personal well-being within the workplace, as well as demystifying clinical governance systems. We plan to further develop our course materials based on our feedback, and deliver the workshops again in 2023.
Improving Emergency Psychiatric Training Experience for Core Trainees in Southwest London
Authors: Scanlon Hannah , Vamathevan Divya 
Published: July 2023

AimsTo improve emergency psychiatry experience for Core Trainee doctors in Southwest London in accordance with the Royal College of Psychiatrists curriculum requirements.MethodsA scoping questionnaire was sent to all core trainees over a 3-month period (February 2022-March 2022) regarding on-call commitments. This incorporated evaluation of emergency psychiatry experience which was provided through Crisis Assessment Team (CAT) on-call shifts. Direct responses were utilised in conjuncture with the feedback from the Junior Doctor Forum and engagement with trust senior management to promptly identify and implement alternative provision of this training need. This resulted in On-call Core Trainee emergency cover being changed from CAT to the Liaison service.A second questionnaire was then sent over a further 3-month period (November 2022-January 2023) to trainees participating in liaison shifts to evidence outcome.ResultsFrom the initial questionnaire a total of 93 responses were collected, with 19 from CAT shifts. Of these, 42.1% indicated they found it was useful in meeting the training need of emergency experience. 47.3% reported no assessments or admissions to the unit over the shift.From the second questionnaire a total of 22 responses were collected from liaison shifts. 77.3% reported the shift to have been useful in meeting the training need of emergency experience. 100% of respondents reported exposure to a wide range of emergency psychiatric presentations over their shift. 63.6% also reported feeling their confidence had improved in managing emergency psychiatric scenarios independently in the future.Overall, this showed a 35.2% increase in trainee satisfaction that their emergency psychiatric training need was being met following the change to on-call arrangements.ConclusionEmergency Psychiatric experience is a curriculum requirement and is vital in preparing for higher training. Consultation with trainees has been used to drive change with evidence of improved exposure to emergency psychiatry, increased trainee satisfaction and enhanced clinical confidence. This has highlighted the benefit of involving trainees in devising provision of training opportunities in this trust and would be recommended in training schemes nationally.
Attachment to Parents and Childhood Trauma in Adolescent Patients With Non-Suicidal Self-Injurious Behaviour
Authors: Abdelhafez Nessma , El-Bakry Azza , Fakher Walaa 
Published: July 2023

AimsTo explore the phenomenon of non-suicidal self-injury (NSSI) in adolescent patients and to assess adolescent-parent attachment and childhood trauma in relation to NSSI behaviour through a case control comparison between adolescents with and without NSSI.MethodsNSSI group included 30 adolescent patients presenting to psychiatry outpatient clinic with history of NSSI. Controls were 30 non-psychiatric adolescent patients recruited from other specialties outpatient clinics. Tools applied were: Semi-structured Psychiatric Interview, Structured Clinical Interview for Diagnostic and Statistical Manual (DSM IV-TR) Axis I and II Disorders (SCID-I and II), Brief Non-Suicidal Self-Injury Assessment tool (BNSSI-AT), Inventory of Parent and Peer Attachment (IPPA)-Parent form, Parental Bonding Instrument (PBI) and Childhood Trauma Questionnaire (CTQ). Patient-rated tools were translated into Arabic language.ResultsSelf-cutting was the primary method of NSSI in 86.7% followed by interference with wound healing in 73.3%. Of NSSI group, 60% met the criteria for diagnosis of borderline personality disorder (BPD) while 16.7% showed only traits. Moreover, 40% were diagnosed with depressive disorders. While 93.3% used NSSI to deal with anger, 80% used it to cope with uncomfortable feelings or to relieve stress and pressure. In addition, 73.3% reported self-injuring because of their self-hatred. The main motivation for initial NSSI was negative feelings such as being upset (90%), being angry at oneself (73.3%) or at someone else (53.3%). Also, 36.7% reported seeing it in media or reading about it while 40% of the motivations were found related to peer pressure. NSSI group scored significantly lower than controls in their attachment to parents (particularly to mothers). A positive correlation was found between perceived parental care and attachment to parents (mainly trust and communication). A statistically significant difference was found between both groups regarding severity of childhood trauma experiences. In NSSI group, emotional neglect was reported in 80%, emotional abuse in 63.3%, sexual abuse in 50% and physical abuse in 46.7%. Perceived emotional neglect was positively correlated with sense of alienation from fathers and negatively correlated with trust in mothers.ConclusionFemales constituted 80% of the NSSI group, primarily with the diagnosis of BPD. The most common method of NSSI was “self-cutting”. A significantly high percentage of adolescents with NSSI described their attachment to parents as insecure. The majority of NSSI patients perceived their relationship to both parents as “affectionless control”. A significant correlation was found between perceived parental care and security of attachment. Results also suggest that different types of child maltreatment might predict later NSSI.
Barriers to Choosing Psychiatry as a Career in Pakistani Medical Students and Junior Doctors – Survey Study
Authors: Ahmed Raja Adnan , Zahid Samrah , Shahab Bisma 
Published: July 2023

AimsIn a majority of low and middle-income countries, the mental health system is weakened due to poor resources as well as poorer recruitment and retention rates in psychiatry among junior doctors. The present study utilizes a mixed-methods approach to explore the factors associated with low recruitment and retention of junior doctors in Psychiatry.MethodsThis study utilized an online survey administered among medical students and postgraduate trainees in psychiatry in Pakistan. The survey was open for 5 weeks for data collection from Nov 21st to Dec 31st, 2022. The survey was distributed conveniently using social media platforms and supplemented by snowball sampling procedures. This survey explored common myths about mental illness and psychiatrists using close-ended questions. Open-ended questions were asked to probe the participants on solutions to improve recruitment into psychiatry be improved.ResultsA total of 103 responses were received on the online survey, with the majority (83, 80%) of respondents being females. A majority (66, 64%) of respondents were medical students and 37 (36%) were junior doctors. Most responses were received from the two largest government sector medical universities in Karachi Pakistan, Jinnah Sindh Medical University (67%) & Dow University of Health Sciences (23%).A total of 62 (60%) respondents reported a lack of exposure to Psychiatry in medical students, to make it a career choice. A larger proportion 57 (55%) felt working in Psychiatry can affect their own mental health. A total of 43 (40%) were not sure if Psychiatry is fulfilling enough as a career and 58 (56%) felt that job satisfaction in psychiatry is difficult to achieve. Around 60% were concerned that mental health conditions are chronic and enduring psychiatrists may not have many options for treatment. In open-ended responses, several common themes emerged. Most respondents commented about their lack of exposure to psychiatry as medical students, which accounts for their reluctance to choose Psychiatry.ConclusionPsychiatry forms a very limited part of the medical school curriculum and students' placements. Myths and stigma around mental illness can lead to low recruitment in Psychiatry and stigma can be challenged with more exposure to psychiatry during medical university years. Early medical study years have an influence on career choice and Psychiatry should be introduced relatively early as clinical placement. Psychiatry conferences, seminars and workshops on the local and national level can help in inspiring Medical students and junior doctors.
National Prescribing Patterns of Psychotropic Medications in Older Adults in Oman
Authors: Al-Shehhi Afaf , Al-Qamshooei Maryam , Al-Kaabi Laila , Al-Suqri Mahera , Al-Kalbani Yahya , Al-Kasbi Salim , Al-Saadi Sumaia , Al-Farsi Asma , Al-Busaidi Safiya , Al-Jahwari Latifa , Al-Hinai Azza , Al-Balushi Manal , Al-Shekaili Waleed , Al-Sinawi Hamed 
Published: July 2023

AimsHigh rate of psychotropic medications use in elderly people has been reported in the literature. Potentiality inappropriate prescriptions (PIPs) is very common as well. This issue has not been investigated in Oman previously. The aim of our study was to assess the patterns of psychotropic medications prescribed for older adults in the psychiatry clinics in Oman, screen for PIPs and plan for future actions to minimize inappropriate prescriptions.MethodsThis is a cross sectional descriptive study using the information in patient's medical records. It was conducted in 12 health care institutions which equally represent all Governorates of Oman. All patients who aged ≥ 60 years old who attended psychiatry clinics from January 2019 to June 2021 and were prescribed psychotropic medications were included. All psychotropic drugs were evaluated including: antidepressants, antipsychotics, Mood stabilizers and hypnotics. STOPP criteria were applied to detect PIPs.Results1409 patients (70%) out of 1995 elderly patients who attended the psychiatry clinics in the study period as a new case were prescribed psychotropic medications. Rate of polypharmacy in our study is 38.9%. The most common medications prescribed were risperidone (18.1%) from the antipsychotic category, citalopram (23%) from the antidepressant group and promethazine (30.1%) from the hypnotics group. Regarding the use of sedative medications,18.5% of the patients were prescribed a benzodiazepine and 35.6% of them were prescribed an antihistamine. When assessed the pattern of medications prescribed in healthy people compared to people with different categories of major medical morbidities, no differences were observed. We found 130 (9.3%) potentially inappropriate prescriptions in our study based on STOPP criteria which included use of long-acting benzodiazepine (Diazepam), prescription of anticholinergic medication to treat extrapyramidal side effects (procyclidine) and use of tricyclic antidepressants in specific categories of medical diseases.ConclusionThe patterns of psychotropic prescriptions for older adults in the outpatient setting in Oman raise concerns about 2 main issues: psychotropic polypharmacy and high rate of benzodiazepines and antihistamines use. This warrants further investigation of these issues in separate studies to identify risk factors. We also recommend implementing certain actions to minimize inappropriate prescriptions including reviewing the availability of appropriate psychotropic medications for this age group in Oman, creating a national guideline for prescribing and providing continuous medical education to the physicians in the primary and secondary health care institutions regarding this aspect.