bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Burnout in Intern Doctors on a Compulsory Rotational Internship in the Aftermath of the 2nd and 3rd Wave of COVID-19, Conducted in a Tertiary Hospital in Kolkata, India for the Academic Year 2021–2022
Authors: Choudhury Sagarika 
Published: June 2022

AimsIntern doctors are the backbone of the hospital infrastructure. While they are the first to provide patient care on an Emergency and Elective basis, they also happen to be the junior most. The interns of the year 2021–2022, apart from working in various departments of the hospital, were also the frontline workers in the 2nd and the 3rd wave of the COVID-19 pandemic. In the current global public health crisis, interns are more exposed to physical and mental exhaustion, owing to being overworked, along with carrying the burden of loss of patients, colleagues, and potentially infecting themselves and their loved ones to COVID-19. Burnout, a psychological syndrome that occurs due to work-related stress, includes emotional exhaustion (EE), depersonalisation (DP), and a sense of reduced personal accomplishment (PA). Intern doctors run a high risk of facing burnout—the prevalence of which is yet unknown. Hence, the survey was conducted.MethodsAn online survey was carried out using MASLACH BURNOUT INVENTORY (MBI) among interns with their voluntary participation. 22 symptom items pertaining to occupational burnout were assessed, with three-component scales: emotional exhaustion (9 items), depersonalisation (5 items), and personal achievement (8 items), with a 7-level frequency scale for all MBI scales and 0–6 scoring.Responses were received from 180 interns (n = 180). Questions regarding current department postings and contraction of COVID-19 were included in the survey.ResultsBurnout was prevalent in most interns who tested positive for COVID-19 = 60% (108), followed by those whose family members tested positive for COVID-19 = 23.8% (43).Burnout was seen more in female interns = 30% (54) than in males = 10.56% (19).Burnout was seen more in interns working in the Emergency and Trauma = 41.67% (75), and the least in Ophthalmology = 1.67% (3).ConclusionBurnout is significantly prevalent in intern doctors at the end of the academic year, especially due to the COVID-19 pandemic. Burnout can lead to increased medical errors, reduced patient satisfaction, which affects the quality of patient care. Understanding risk factors, improving workplace environment, limiting duty hours, workshops promoting healthy behaviours have been suggested to reduce burnouts and to prioritise both mental and physical health of interns so as to ultimately improve patient care.
Amblyopia: An Uncommon Presentation of Paediatric Conversion Disorder
Authors: Mallik Chiro Islam , Mullick Mohammad Sayadul Islam 
Published: June 2022

AimsConversion disorder is common among children and adolescents, particularly in non-Western societies like in Bangladesh. Diverse presentation of the disorder makes it difficult to diagnose which ultimately may lead to poor prognosis.MethodsPatient X is a 10-year-old girl, a 5th grade student, hailing from a District town, Bangladesh, attending child and adolescent consultation services with the complaint of sudden loss of vision in both eyes for 3 weeks. Earlier, she underwent thorough examination and investigation and intervention by the different specialists (GP, ophthalmologist, and neurologist). At one point she was given zero power glasses. Her symptom was then fluctuating. She was not attending school as she was away for treatment purposes. X complained of not seeing lines of books when her parents tried to persuade her to do schoolwork at home. Eventually she was referred for psychiatric evaluation after no improvement. Assessment was completed and parental discord, violent act of father towards mother, overprotective as well as inconsistent parenting, attention seeking behaviour of X were identified. General and systemic examinations were normal. Her finding was inconsistent with any physical disorder. Investigation was normal. Thus, diagnosis of conversion disorder was given. General treatment (reassurance, psychoeducation, adopting daily life programme) along with specific treatment (symptom reduction by suggestion, relaxation, and family therapy) were provided. Improvement was noted during the follow-ups.ResultsThe conversion disorder of this girl happened at her period of transition from childhood to adolescence. Psychopathology of hysteria still is not clear despite huge research efforts. Based on psychodynamic explanations, the core psychopathologies of her symptoms are primary gain - resolution of her witnessing severe parental discord that she failed to cope with happened through her presenting symptoms without awareness though later she does in awareness; secondary gain- she receives additional reinforcement in the form of extra care, parental help seeking behaviour, unnecessary interventions, demand fulfilment that mostly present in awareness. Other psychopathologies are conversion- the patient's psychological distress converted to presenting somatic symptoms through an intrapsychic process; repression-la belle indifference of the patient has developed through a process of displacing distressful experience, from awareness that gives relief to the distress.ConclusionManifestations of conversion disorder can simply be explained as cry for help, give indication of the problem areas, help in understanding personality traits, making intervention and prevention plans. Early identification of stressors is crucial for the treatment of this disorder.
Association of ADHD With Congenital Conditions – Case Reviews in General Adult Clinic
Authors: Roy Dipayan 
Published: June 2022

AimsThe association of ADHD with mental health and medical conditions is commonly encountered in clinical practice. Interestingly there are patients with congenital conditions who present with features of ADHD and little is known about their association and neurological basis. There is no strong literature but anecdotal reports that indicate children with congenital heart disease are more likely to suffer from mental health conditions including ADHD. The clinic however is unable to analyze such hypothesis and instead decided to evaluate cases related to Neurofibromatosis (NF1), Arnold Chiari Malformation, Transposition of great arteries, Di George syndrome to understand the longitudinal history, symptom persistence and functional impact of ADHD.MethodsA.Index patient aged 45 years referred for possible association of ADHD and Neurofibromatosis with issues related to long-standing trouble with sleep and movement disorder.B.Index patient aged 41 years received a surgical repair for a Chiari malformation hoping it would improve the cognitive functioning but still suffers lot of symptoms that are consistent with clinical picture of ADHD.C.Index patient aged 19 years referred for ADHD assessment reported history of transposition of great arteries and VSD that warranted emergency operative procedure before age 3. The behavioural symptoms that were suspected as related to physical illness and frequent attendance to hospital however did not resolve and were noted to be in line with possible ADHD.D.Index patient aged 40 years admitted to general psychiatry following episode of psychosis and during examination presented history of Di George syndrome with brief input from Cardiology. It was apparent that patient struggled with poor understanding, lack of consistency, disorganization, distractibility, learning difficulties and the features suggested a pattern of Attention deficit disorder.ResultsFocused on
1.The qualitative analysis of developmental history, childhood rating scale, symptom comorbidity and functional impairment of such cases.2.It studied the family history of physical and mental illness including predisposition to ADHD or neurodevelopmental conditions.3.It also evaluated the treatment response to stimulant/non-stimulant therapy.ConclusionClinically there was no typical co-relation of increased mental illness or genetic predisposition for ADHD in the family history and qualitatively the presentation did not differ from other ADHD patients and the treatment response was not variable, however it still draws attention towards the need for regular screening of all nervous and cardiac origin congenital conditions for an early intervention.
The Various Faces of Creutzfeldt-Jakob Disease (CJD); a Case of CJD Presenting as Psychosis in a Middle-Aged Woman
Authors: Sodiya Olusegun , Odutola Akinkunmi , Hakeem Michel 
Published: June 2022

AimsCreutzfeldt-Jakob disease (CJD) is a rare, progressive, fatal neurodegenerative disorder caused by an abnormal glycoprotein known as the prion protein. The core features include progressive cognitive decline, cerebellar dysfunction, personality changes, and visual disturbances. Although psychiatric symptoms are rare, they can be the primary symptom of CJD, and such presentations can pose diagnostic difficulties. In this paper, we describe the case of Ms. R, who manifested psychotic symptoms as the first signs of CJD.MethodsMs. R, was a 49-year-old white British female not previously known to psychiatric services, who presented with acute onset of florid psychotic symptoms. Her symptoms included auditory hallucinations, paranoia, and thought disorder. She was treated with antipsychotics for over four weeks, following her admission, but no improvement was seen. Instead, her psychosis worsened with cognitive decline, mutism, and the appearance of neurological symptoms such as jerky body movement, ataxia, and falls. All screening blood tests, chest X-ray, and CT abdomen were normal. The MRI, however revealed few patches of high T2/FLAIR signal in the deep white matter. Cerebrospinal fluid showed increased protein. Neurologist reviews suggested the possibility of sporadic CJD (sCJD) as a probable diagnosis. As her condition deteriorated, she became comatose and died four months after the appearance of the first psychiatric symptoms.ResultsIt can be challenging to diagnose CJD since the clinical picture overlaps with other neuropsychiatric and neurodegenerative conditions. It requires the presence of relevant clinical findings along with positive CSF, EEG, or MRI findings to make a probable diagnosis. Regarding our case, some noteworthy observations were psychosis as the initial symptom, relatively delayed onset of neurological signs, rapid deterioration with brief duration of illness. The MRI findings were typical of those seen in sCJD, although the EEG did not suggest sCJD. A differential of variant CJD was considered because of her age, prominent psychiatric symptoms, and delayed neurological signs.ConclusionCreutzfeldt-Jakob disease course is rapidly progressive, and majority of patients die within one year. Therefore, awareness of early clinical features is of great significance. Among other things, this would enable patients and their families time to understand the nature of CJD, prognosis and prepare advanced directives. This case adds to the growing number of atypical presentation of CJD as well as pointing to an expanding spectrum of the disease. Therefore, clinicians should consider CJD in the differential diagnosis of new-onset psychosis, particularly if symptoms persist and worsen despite standard psychiatric treatment.
Patient Initiated Follow-Up (PIFU) Within Adult Secondary Care Mental Health Services
Authors: Wilkinson Andrew , Srireddy Pavan 
Published: June 2022

AimsThe traditional ‘one size fits all’ model within secondary care mental health (MH) settings of regular appointments scheduled by a clinician at defined intervals isn't always responsive to an individual's changing needs. Previous reviews have shown significant levels of patient and clinician satisfaction with Patient initiated models of review in a variety of healthcare settings but its use within secondary care MH settings has been relatively limited. We describe the development and implementation of a Patient initiated follow-up (PIFU) pathway within MH services in NHS Greater Glasgow and Clyde (GG&C).MethodsThe pathway was developed by a small working group of clinicians with input from local management and eHealth colleagues with an emphasis on the principles of Realistic Medicine. There was input from peer support workers and the Mental Health network, a local service user organisation, into the development of the pathway. The pathway underwent a ‘test of implementation’ within three adult CMHT's with support from the development group. Feedback from the test sites was used to modify the pathway and ultimately support the wider rollout of the model across all seventeen CMHTs within NHS GG&C over the course of 2021. Formal evaluation of the pathway, including patient and clinician satisfaction, service utilisation as well as safety measures, is due to be undertaken at 12 months after full implementation.ResultsThe tests of implementation identified a range of factors that needed to be considered as part of the introduction of a PIFU model into MH settings.Patient choice and shared decision making along with other clinical factors such as level of insight, availability of other supports, shared risk assessments and current clinical need were identified as relevant patient related factors. Clinician related factors included concerns about applicability within MH settings, perception of risk, increase in workload and appropriate identification of suitable patients. Regular meetings between the clinicians in the test sites and members of the development group as part of the implementation process helped address clinicians concerns and ultimately supported uptake of the model.ConclusionOur experience highlighted the potential for a personalised approach to care planning in empowering patients have a more active role in the way they access services as part of their recovery journey. It also highlighted patient and clinician related factors that need to be considered for a successful adoption of the model.
Adult ADHD Patients in Community Mental Health Teams – an Unmet Need
Authors: Agabani Ayat , Cornwall Lenny , Gupta Sumeet , Oatway Helen , Ingram Hayli 
Published: June 2022

AimsThis Service Survey is a part of a Quality improvement project which aims to :1- To assess the extent of the problem regarding accessing Adult ADHD assessment and treatment by getting the views of clinicians.2- Evaluate negative impact on care coordinators of the delay in accessing timely and effective diagnosis and treatment of ADHD; This will: a-Increase understanding of the care needed by this patient group. b-Clarify current practice and any difficulties staff face in condition management when diagnosis not confirmed i.e. outline training needs. c-Determine if waiting time for diagnosis results in iatrogenic harm (deterioration driven by ‘unmet need’). 3-Inform the development of an alternative pathway of care; thus: a-Reduce inequality of healthcare access for those with this neurodevelopmental condition. b-Reduce stigma. c-Improve service user health and well-being. d-Support families and carers. e-Reduce social costs to individual and community. f-Support community staff and increase knowledge and effectiveness.MethodsMethods of the service survey part:
1.Service survey: Sent to 21 consultants who are working in Adult CMHT.2.Service Satisfaction survey for all of the Redcar & Cleveland Affective disorder team's clinical staff members (18).Results: Consultants Service Survey11 consultants responded out of 21 (52%)Approximate number of the diagnosed ADHD patients / team varied between 7–80 patients.Wait time for an ADHD assessment varied between 12 -30 months.Number of patients/ team waiting for assessments by the specialist team 2- 27 patients.50% of the consultants reported significant delays between referral to the services and initiation of treatment 6–36 months.All consultants reported commencing treatment of ADHD, if a patient already had the diagnosis.9/11 (82%) consultants reported making the initial diagnosis and treating ADHD patients in CMHTs. However, all consultant reported the need for further training in assessment and management of ADHD patients.6/11 (55%) consultants stated that ADHD patients should be managed in CMHTs provided they are care coordinated by another clinician.Clinical Staff Satisfaction SurveyAll 3 staffs responded out of 18 staff, reported un satisfaction with the current service provision.Conclusion1.The current service model is not able to meet the increasing demand for the services and leading to significant delay in accessing appropriate treatment.2.There is a need to improve competencies of community mental health teams to manage these patients.3.This survey will be used to model a new care pathway.
Clinicians’ Experience of Remote Assessment of Autism Spectrum Disorder Within the Barnet CAMHS Service
Authors: Constantinescu Simona , Gupta Jaya , Fedyushkin Itit Arora , Fernandez-Chirre Adriana 
Published: June 2022

Aims1. To evaluate clinicians’ experiences of the newly implemented remote ASD assessment process (due to COVID-19), including the long-term sustainability and potential standardisation of this approach; 2. To establish areas for improvement in this process and make further recommendations.MethodsMembers of the Neurodevelopmental MDT completed an online survey, whereby feedback was collected regarding the use of the Child Observation of Social Communication (COSC), which had been adapted for online use from the standardised Autism Diagnostic Observation (ADOS) Schedule by a senior Psychologist[.Participants also responded to questions on other assessment domains, including the Developmental, Dimensional and Diagnostic interview, feedback and formulation meetings. Questions included their comfort with performing the assessment, theirs views on the quality of care provided and any difficulties they faced. Survey data were collected on two occasions: between November and December 2020 and between July and August 2021.ResultsPositive Experiences63% of respondents in November-December 2020 reported that COSC was a good alternative whilst standardised ADOS was unavailable. This increased to 100% in July-August 2021. Quality of care delivered by COSC was rated to be the same as ADOS in 70% of participants November-December 2020; 25% felt quality of care delivered by COSC was better than ADOS in July-August 2021. 73% of participants reported they would continue to use the remote assessment in the November-December 2020 survey. This increased to 88% in July-August 2021. 33% of the clinicians were very comfortable with administering the COSC in July-August 2021, 56% were somewhat comfortable.Negative Experiences27% of the clinicians reported being somewhat uncomfortable with administering the COSC assessment in November-December 2020; 11% remained somewhat uncomfortable in July-August 2021. 30% of the participants rated the quality of care delivered by COSC worse than ADOS in November-December 2020. 37.5% rated this to be worse in July-August 2021. 77% of the respondents had technical or organisational difficulties, which could result in missing non-verbal cues during the assessment.ConclusionClinicians’ experiences improved over time and with practice (34% had delivered over 10 COSC assessments in July-Aug 2021). A hybrid model may increase the quality of care of the approach, as well as careful selection of cases which would be suitable for an online assessment. There is scope for the continued use of the remote ASD pathway, taking into account patient and clinician preferences, however patient feedback will be necessary as a next step in this evaluation.
Identifying Transition to First Episode Psychosis (FEP) From ‘At Risk Mental State’ (ARMS) in Sussex Early Intervention in Psychosis (EIP) Services
Authors: Davies Emma , Whale Richard 
Published: June 2022

AimsIdentification of a psychosis risk syndrome to aid reduction of transition to a FEP is an important focus of worldwide research. ARMS for psychosis was defined by Yung and McGorry in 1996. UK EIP services were mandated to identify and ‘treat’ ARMS in the ‘Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance' 2016. Sussex EIP services developed such an ARMS service with a 1-year pathway of assessment, intervention as indicated, and monitoring from 2017. Sussex serves a population of approximately 1.4 million, including areas with both low and high social deprivation indices. Transition rates from ARMS to FEP in recent studies have suggested widely varying rates of 8–17% of transition in a two-year period, notably less than initially identified by Yung et al. We aimed to establish the rate of transition to FEP within 12 months from identification of ARMS in Sussex EIP services.MethodsA retrospective study was conducted on all patients on the ARMS pathway, across five EIP services in Sussex, between Jan 2017-Oct 2021. The primary outcome measure was operationally defined transition to FEP; secondary outcome measures included clinical features and use of clinical services.Results71 cases were identified as meeting ARMS criteria, with mean age 21.4yo; range 14–35, from a total new caseload of 447 over this period.ARMS subcategories identified 4 state/trait, 55 attenuated psychosis and 12 BLIPS. Comorbidity was more common than not; mood disorders were identified in 17 cases. 23 cases met not in education, employment or training (NEET) criteria.All cases received full care coordination by lead practitioners. 19 cases were prescribed atypical antipsychotics. 18 cases received formal CBT.4 of the 71 cases transitioned to FEP within 12 months at mean time 35 weeks; range 28–45 weeks. 2 had attenuated symptoms and 2 experienced BLIPS. 3 were initially NEET.ConclusionWe report a very low transition rate to FEP of 6% in this service, consistent with other such UK services. Whilst the ARMS sample is low in number, a clear impact on EIP service case management is identified. Risk saturation is arguably required to justify continuing this ARMS pathway, achievable by primary focus on the BLIPS subgroup. Wider review of UK ARMS services is required to reduce dilution of EIP service models and reduction of their well evidenced effectiveness.