bluuebunny/crossref_metadata_2025_split huggingface dataset:
Understanding the Developmental Pathways and Onset of Bipolar Disorder and Borderline Personality Disorder in Young People: A Systematic Review of Reviews
Authors: Durdurak Buse Beril , Upthegrove Rachel , Altaweel Nada , Marwaha Steven 
Published: June 2022

AimsThere is still an ongoing debate on the nosological position of Bipolar Disorder (BD) and Borderline Personality Disorder (BPD). Identifying the unique and shared risks and developmental pathways in emerging BD and BPD could help the field refine aetiological hypotheses of these disorders. The study aims were to systematically synthesise the available evidence from systematic reviews and meta-analyses concerning environmental, psychosocial, biological, and clinical factors leading to the emergence of BD and BPD to identify the main differences and common characteristics between the two disorders to characterise their complex interplay whilst highlighting remaining evidence gaps.MethodsA literature search was conducted PubMed, PsychINFO, EMBASE, Cochrane, CINAHL, MEDLINE, and ISI Web of Science as the data sources. 19 systematic reviews and meta-analyses involving 217 prospective studies met eligibility criteria.ResultsResults demonstrated that family history of psychopathology, affective instability, attention deficit hyperactivity disorder, anxiety disorders, depression, sleep disturbances, substance abuse, psychotic symptoms, suicidality, childhood adversity and temperament dimensions were common predisposing factors across both disorders. There are also many distinct variables that could be found early in the course of both disorders. Most of the factors should be considered as a general, nonspecific precursor signs and symptoms of both BPD and BD, apart from subsyndromal depression, subsyndromal hypomania, cyclothymia disorder, psychotic symptoms, age at onset of major depression and frequency and loading of affective symptoms.ConclusionAlthough the findings of this review may lead to support the view of BD and BPD as two distinct disorders, there is not sufficient data to either indicate that BD and BPD are separate nosological entities or that BPD should be considered as an extension of BD disorders. Future research is required to increase our understanding of the aetiology of BD and BPD onset and their complex interplay by conducting prospective studies which concurrently examine multiple measures including biological, environmental, psychosocial and clinical factors in BD and BPD at-risk populations. Large, multilevel data sets will enable deep phenotyping and distinguish pathophysiological pathways.
Is Cannabis Abstinence Related to Subsequent Reduced Risk of Psychosis? a Nested Retrospective Case Control Hierarchical Survival Analysis
Authors: Gafoor Rafael 
Published: June 2022

AimsThere is strong evidence from systematic reviews and meta-analyses that cannabis use is related to an elevated risk of developing a subsequent psychotic illness. It is less clear if the length of cannabis abstinence is related to the risk of developing a psychotic episode. We explore the relationship between length of cannabis abstinence and subsequent risk of a psychotic episode.MethodsWe included patients aged 18–64 years who presented to psychiatric services in 11 sites across Europe and Brazil with first-episode psychosis and recruited controls representative of the local populations. We excluded all patients who reported no past history of cannabis use. We carried out hierarchical survival analyses on probability weighted data to examine the relative hazards of cessation of cannabis abstinence between cases and controls. Data on cannabis abstinence were collected retrospectively by participant recollection. We controlled for ethnicity, age, length of education and history of cigarette smoking. Proportionality assumptions were verified using Kaplan Meier plots, log-log plots and scaled Schoenfeld residuals. There was some evidence of non-proportional hazards and the assumptions of proportionality were relaxed by introducing caseness as a time varying co-variate with time specified as its natural log.ResultsWe included 506 cases and 482 controls with a mean age of 30.12 years (sd = 9.97). Cases had an elevated hazard ratio of cannabis use versus cannabis abstinence in controls (HR = 6.11 [SE = 1.43; p = <0.001]). There was no evidence of a difference associated with ethnicity (p = 0.198) but there were statistically significant differences at the 5% level between age groups. Ages 23–27 had a hazard ratio of 0.528 (SE = 0.064; p <0.001) versus those 18–22 years old. For ages 28–32, 33–44 and 43 to 64, the hazards ratios were 0.311, 0.110 and 0.100 (all statistically significant; p<-0.001) respectively.ConclusionAbstinence of cannabis use is related to a reduced hazard of having a subsequent psychotic episode. The magnitude of the hazards for a subsequent psychotic illness is highest in those 18–22 years old and decreases with increasing age. Cannabis cessation maintenance therapies may have greater impact if targeting younger rather than older cannabis users who are at an elevated risk of developing a psychotic illness.
Diabetes Care in the Psychiatric Inpatient Setting: A National Survey of Mental Health Professionals Knowledge, Attitudes and Skills
Authors: Goff Zoe , Varvari Ioana , Sharma Vishal 
Published: June 2022

AimsPeople with Severe Mental Illness (SMI) are at increased risk of developing diabetes. There is currently a lack of monitoring and standardisation of diabetes care in the NHS psychiatric inpatient setting. This presents as a missed opportunity, as inpatient admission could be used to improve diabetes care for this population. We surveyed the multi-disciplinary teams in psychiatric inpatient units across England to develop understanding of current diabetes care in this setting.MethodsA 13-item questionnaire was designed to assess the knowledge, attitudes and skills relating to diabetes care. This was piloted via think out loud interviews with 5 staff at a Forensic unit. Amendments were then made to the questionnaire to improve the validity prior to national roll-out.Site coordinators working within General Adult, Old Age, Rehabilitation and Forensic inpatient services were recruited via medical education and academic links. This included 19 inpatient sites within 11 NHS Mental Health Trusts across England. Site coordinators circulated the questionnaire, primarily via electronic survey. A small number of paper responses were also collected.Results156 responses were collected via the national survey (electronic = 136, paper = 20). 6 responses were excluded due to missing professional role information or roles not involving physical healthcare. Respondents included within the analysis comprised 43 Doctors, 55 Nurses and 52 Allied Healthcare Professionals.93% of respondents agreed that addressing physical health needs was an important part of the mental health team's role, although only 28% had received physical healthcare training within the last 12 months.68% agreed that they had adequate skills and knowledge to manage diabetes safely on the ward. 69% agreed that the diabetic care on the ward was of an acceptable standard according to National Institute for Health and Care Excellent (NICE) guidelines. This reflects a need for appropriate training and guidance to help improve this aspect of care.Additionally, only 51% agreed that they felt able to refer a patient with diabetes to the most appropriate diabetes service based on type of diabetes and medication prescribed. This highlights an important issue, as cohesive shared-care and clear referral pathways are key when considering effective diabetes management.ConclusionPsychiatric inpatient admission could be used opportunistically to improve the healthcare disparities for people with comorbid diabetes and SMI. This national survey highlights key areas that would need to be addressed to standardise and optimise diabetes care in this setting. This includes appropriate training, clear guidelines and cohesive shared-care pathways.
A Narrative Review of Defensive Medical Practice in Psychiatry
Authors: Hassanally Khalil 
Published: June 2022

AimsDefensive medical practice has become an increasingly global phenomenon and encompasses all medical specialties. In the UK it was defined in the case of Sidaway v Board of Governors of the Bethlem Royal Hospital [1985] UKHL 1 (21 February 1985) as “the practice of doctors advising and undertaking the treatment which they think is legally safe even though they may believe that it is not the best for their patient”. This narrative review surveys the literature to establish the forms in which defensive practice may manifest itself within psychiatry.MethodsIn this narrative review, various terms pertaining to defensive medical practice in psychiatry were searched in both medical and legal databases.ResultsThough the literature in psychiatry compared to other medical specialties is more limited, some common themes occur across all jurisdictions surveyed. Defensive psychiatric practice included admitting the patient even though they may be managed within the community (as reported by 21% of psychiatrists surveyed in the North of England) and employing more coercive practice, either using the mental health legislation or implied or actual threats. Once hospitalised, defensive practice manifests itself by placing patients on higher levels of nursing observations than necessary.Across inpatient and outpatient settings between one and two thirds of psychiatrists reported altering the way they document to attend to medicolegal considerations. Prescribing habits were also altered due to fears of litigation; an Israeli study found that almost half of psychiatrists surveyed reported they prescribed smaller doses of medication than what they felt was required to pregnant woman and ninety percent reported the same when it came to the treatment of elderly patients.When looked at by seniority it was felt that junior doctors were more prone to admitting patients defensively than consultants. In this respect, psychiatry differs from most other medical specialties as, in general, the evidence suggests that increased seniority is more likely to lead to admission.ConclusionDefensive practice in psychiatry appears to be widespread and takes a number of different forms. However, the research in psychiatry is limited and does not explore key areas common to other medical specialties such as clinician avoidance of certain cases or increased use of diagnostic tests. Furthermore, there is little examination of how psychiatrists may utilise mental health legislation within their defensive practice.
Psychiatric Morbidity Among the Patients of First Ever Ischaemic Stroke
Authors: Inam Muhammad Sayed 
Published: June 2022

AimsTo evaluate psychiatric morbidity among the patients of first ever ischemic strokeMethodsThis sectional comparative study was carried out in the Department of Psychiatry, Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from 1st July 2013 to 30th June 2014. Sixty six ischaemic stroke patients of first attack between 2 weeks to 2 years of stroke, aged above 18 years irrespective of sex and 66 accompanying healthy person of the patients and other patients without any kind of stroke matching age and sex fulfilling inclusion and exclusion criteria were taken in Group-A and Group-B respectively. Diagnosis of ischaemic stroke was made in these patients by the consultant neurologists reviewing the history, clinical examination and accompanying investigations reports specially CT scan of brain. Psychiatric assessment was done using General Health Questionnaire (GHQ12) as screening tool. All GHQ12 positive cases were evaluated using mental state examination and recorded in a MSE sheet. Diagnosis of psychiatric disorders of all respondents was confirmed by psychiatrist according to DSM-5 criteria.ResultsThe patients with ischaemic stroke and control subjects were similar in age [57.6 (SD ± 5.5) years vs 57.1 (SD ± 4.5) years; p > 0.130] and sex [48 (72.7%) male and 18 (27.3%) female vs 45 (68.2%) male and 21 (31.8%) female; p = 0.567]. Comorbid psychiatric disorder was found in 23 (34.8%) patients of ischaemic stroke and 9 (13.6%) control subjects. The comorbid psychiatric disorder was significantly higher in patients of ischaemic stroke than that of control g subjects (p = 0.004). Comorbid specific psychiatric disorders were generalized anxiety disorder in 9 (13.6%) and major depressive disorder in 14 (21.2%) in stroke group; while comorbid specific psychiatric disorders were generalized anxiety disorder in 2 (3.0%) and major depressive disorder in 7 (10.6%) respondents in control group (p < 0.013).ConclusionComorbid psychiatric disorders are quite common among patients with first ever ischaemic stroke in the form of major depressive disorder and generalized anxiety disorder. Therefore, attention should be paid to the anxiety and depressive symptoms in stroke units and try to relieve the patients’ emotional stress and personal suffering, which could improve their neurological outcome.
Investigating the Role of Ethnicity and Religion or Spirituality on the Risk of Self-Harm in Children and Adolescents: A Systematic Literature Review
Authors: John Lin 
Published: June 2022

AimsAround the world rates of self-harm vary, placing immense strain on health services. Approximately 20% of children and adolescents are thought to engage in self-harm. The systematic review aims to explore the characteristics, risks and protective factors of ethnicity and religion on self-harm in comparison to the general population. Better identification of risk factors can help professionals and local authorities develop intervention programs to mitigate the incidence of self-harm.MethodsThe Population, Exposure, Outcome, Study design and setting (PEOS) was used as a framework to formulate the question for this systematic review. A literature search was conducted using EMBASE, MEDLINE and APA PsycInfo databases and all English articles published between 2010 and 2020 were screened against the inclusion and exclusion criteria.ResultsFourteen studies which met the criteria were identified and appraised using the Joanna Briggs Institute (JBI) critical appraisal checklist.Unintentional injuries, sexual behaviours, adverse childhood experiences, health status and poverty alongside racial discrimination were associated with self-harm and or suicidal ideation in ethnically diverse populations. In African Americans, Hispanics and Whites, violence or physical altercation, illicit substance misuse, sadness and hopelessness increased the risk of self-harm and or suicidal ideation. The association of subtle forms of discrimination and suicidal ideation was noted to be statistically significant for African Americans, whereas for Latinx this was only marginally increased. Low mood and hopelessness in African American girls, substance misuse in American Indian youths, and aggression in the Caribbean cohort were also noted to present with increased self harm.Adolescent's religiosity and parental monitoring had both a direct and an indirect role for suicidal ideation reduction. Religious importance and attendance at religious services by offspring and parents decreased self-harm in female adolescents more than males.There was a wide heterogeneity in the population and factors reviewed in the different studies, hence pooling of data for meta-analysis of the quantitative studies was not appropriate to estimate prevalence or association between factors and characteristics of the population.ConclusionThis narrative synthesis provides evidence that minority ethnic groups have unique factors, which can increase the rate of self-harm. Religion or spirituality favours a protective role in self-harm or suicide but not for suicidal ideation, although there were only a limited number of articles exploring this.Future studies should focus on defining the ethnic groups further and exploring this and religious factors on a wider scale using standardised parameters.
Afghanistan and the Global Heroin Trade
Authors: Kinally Eamonn 
Published: June 2022

AimsIn 2020, Afghanistan supplied around 85% of the world's heroin. The recent Taliban takeover and political upheaval seems highly likely to impact the supply chain, but how? This literature review aims to explore the background of heroin production and possible consequences of the recent conflict, both for suppliers and for end users.MethodsIn addition to recent mainstream media news articles on the Afghanistan conflict, PubMed search terms “heroin adulteration” were used to find 202 results. Only results published from the year 2000 onwards were examined for relevance, leaving 160 results. These were reviewed for relevance and led to suggestions of similar PubMed articles to arrive at the final 23 sources used.ResultsStudies of previous heroin shortages in Australia and the UK are discussed to gain insight into the potential effects of a future shortage. A reduction in heroin exports from Afghanistan would cut down the supply to most nations excluding North and South America. Sources of evidence for our current understanding of the supply chain are examined. Specific US and UK policy failure which led to the current situation is also provided for context.Methods of production in Afghanistan and smuggling routes are also examined to help predict impending changes.ConclusionGiven the number of factors involved it is difficult to anticipate with much certainty how the Taliban takeover of Afghanistan will affect the global heroin trade, but based on the available literature it seems more likely that this will cause shortages rather than an increased supply.Clinicians should be aware that in line with previous shortages, this may cause a shift towards increased rates of polysubstance use in regular heroin users. We may also see a rise in incidents of harm from heroin adulteration with substances other than the currently widespread paracetamol and caffeine.
Campus Close-Down Came in Handy: Depression, Anxiety and Stress Among Sudanese Medical Students and Their Association With Brief and Extended Closure Periods
Authors: Magzoub Hamid , Osman Mohammed , Mohamed Mohamed 
Published: June 2022

AimsTo estimate the prevalence of depression, anxiety and stress among Sudanese medical students and investigate the relationship and impact of closure periods on depression.MethodsA cross-sectional analytical study was conducted. Data were collected from 1676 enrolled students from 10 medical schools in the capital of Sudan - Khartoum- who faced complete lockdown and agreed to participate in online google form. A self-administered questionnaire containing depression anxiety and stress scale (DASS-42) and socio-demographic inquires was used.ResultsThe chief responders were females 1158 (69.1%) while males were 518 (30.9%). The prevalence of stress symptoms was the highest (51.9%), followed by depression symptoms (49.8%) and anxiety symptoms (28.8%). 96 students attempted suicide (6%) and about 5 folds have suicidal ideation (27%). According to multiple binary logistic analyses, college closure time was significantly associated with decreasing chances of getting depression symptoms (OR: 0.39, 95% C.I: 0.21–0.70, p = 0.002), while being a female, COVID-19 patient or having a family history of depression appeared to elevate depression, anxiety and stress levels. The impact of university closure on stress and anxiety is non-significant.ConclusionDepression, stress, and to a lesser extent anxiety are widespread among Sudanese medical students and suicidal ideation is noteworthy. All of these require serious and expeditious interventions. Controversially, our findings suggest that university closure serves as a protective factor, relieving depression in medical students but not exaggerating it.
Neuromodulatory Effects of Adjunctive High Definition Transcranial Direct Current Stimulation (HDtDCS) on Auditory Verbal Hallucinations in Schizophrenia Patients: A Sham Controlled Diffusion Tensor Imaging Study
Authors: Mahato Apurba Narayan , Munda Sanjay Kumar , Pratap Alok 
Published: June 2022

AimsTo see the neuromodulatory effects of adjunctive HD-tDCS on white matter connectivity by using Diffusion Tensor Imaging (DTI) in schizophrenia patients with Auditory Verbal Hallucinations (AVH)MethodsThis was a randomized, double blind, sham controlled study. 40 patients of schizophrenia with prominent auditory verbal hallucinations and 10 age sex matched healthy controls were selected. The patients were randomly assigned to 2 groups and were given active or sham adjunctive HDtDCS (Active Treatment = 10 sessions of 2 mA current applied for 20 minutes, twice daily for 5 days, at left temporo-parietal Junction (TPJ); Sham treatment = 10 sessions of 1 mA current, twice daily for 5 days was applied for 30 sec at left TPJ). Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed and severity of schizophrenia symptoms and auditory hallucinations were rated on PANSS and PSYRATS-AH at baseline, after 1st week (i.e. end of HDtDCS sessions) and 4 weeks after the end of the HDtDCS sessions). Patients received stable dose of antipsychotics for the total study duration (equivalent to or more than 400 mg of chlorpromazine) to eliminate confounding bias. Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed in healthy controls. DTI data were analysed by DSI Studio software. Statistical analysis was done by SPSS version 25.Results1.Both the patient groups were comparable with regard to socio-demographic variables and baseline clinical variables.2.There was no significant difference in the values of Fractional Anisotropy in Left Arcuate Fasciculus among the patients and healthy controls at baseline.3.The group receiving active adjunctive HDtDCS, showed significant improvement in the frequency domain of AVH over time, in time*group comparison by repeat measure ANOVA with Mauchly's test of sphericity and Greenhouse-Geisser correction [p = 0.011 and partial eta square = 0.129].4.There was no significant difference in change in the Fractional anisotropy of the left arcuate fasciculus noted between the groups over time.5.Application of HDtDCS was not associated with significant side effects, minor itching and mild burning sensation being the only reported side effectsConclusionAdjunctive active HD-tDCS to the left temporo-parietal junction showed a statistically significant improvement in frequency of auditory verbal hallucinations (AVH) in schizophrenia patients, when compared to sham stimulation.