Search

Emigration of doctors is an international, longstanding, and ongoing phenomenon. Emigration of psychiatrists at various levels of their career from the UK to other countries is an occurrence talked about within peer groups and organisations. Here, the authors explore the numbers of trained psychiatrists on the specialist register of the General Medical Council who left the UK in the last five years and their countries of destination. The research uncovers the scale of the issue and the countries that exhibit strong 'pull' factors for psychiatrists. [ABSTRACT FROM AUTHOR]

Aim: In 2016 NICE updated its guidance, extending the age to which early intervention in psychosis (EIP) services treat patients following their first episode of psychosis, to 65 years, from the previous cut‐off of 35 years. The aim of this service evaluation was to identify differences in the demographic details, diagnoses, and treatments between patients below and above 35 years to identify any unmet needs in the latter age category. Methods: A total of 100 patients from the caseload were randomly selected, with 50 from each age group, to analyse in further detail. Descriptive statistics was predominantly used due to the relatively small sample size. Results: The over 35 s were predominantly female (62%), whilst the under 35 s were predominantly male (66%). There was a statistically significantly higher rate of substance misuse in the under 35 s. Whilst schizophrenia was the most common diagnosis in both groups, higher rates of delusional disorders and psychosis NOS were observed in the over 35 s. In both age groups, a median of two different medications was used per patient. However, amongst the over 35 s there is less use of psychological therapy and of support, time and recovery workers (STR workers). Conclusion: There are distinct differences between the two age groups including demographic and diagnostic features. Being historically youth based, EIP services needs to ensure that treatments offered are tailored to meet the need of the older age demographic who have different needs. [ABSTRACT FROM AUTHOR]

Background: In the densely populated slums of Kolkata, informal healthcare providers' (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance.Methods: A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation.Results: Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved.Conclusions: Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up. [ABSTRACT FROM AUTHOR]

In the majority of low- and middle-income countries, mental healthcare is delivered by primary care workers. Often, they are the only contact for patients and their families. Although their knowledge base can be limited, they are expected to manage complex cases with few resources. The authors describe their experience of partnership with mental health centres set up by the Nigeria Health Care Project, and training their primary care workers based on the World Health Organization's Mental Health Gap Action Programme. Although the programme was very effective in helping to upskill their knowledge and experience, a need for continued professional development was highlighted. Based on their feedback, multiple evidence-based options are explored, including the use of remote learning and social media (increased significantly around the world because of the COVID-19 pandemic), to help primary care workers improve their knowledge base and maintain their competencies with the limited resources available. [ABSTRACT FROM AUTHOR]

Mental health remains largely neglected in most low and middle income countries. There is undoubted need to build resources and consolidate training for staff, which is relevant to the mental health needs of the communities in Africa and practically feasible. In this study we present descriptive statistics of diagnostic categories in the patient group attending the outpatient clinics of Edawu---a community mental health center in rural Nigeria. The data shows disproportionately low numbers of clinical contacts for depression. The possible reasons are discussed and strategies including the use of the World Health Organization (WHO) mhGAP Intervention Guide are suggested for the way forward. The study also emphasizes on the potential of the mhGAP intervention guide not only as a tool of assessment and delivery of mental health services but also as a possible instrument of research with available resources. [ABSTRACT FROM AUTHOR]

Establishing the impact of the coronavirus disease 2019 (COVID‐19) pandemic on utilisation of mental health services is a potentially useful means of measuring the psychiatric consequences of the COVID‐19 pandemic and related lockdown. Here, the authors describe their study, which compared the use of an early intervention in psychosis service in the four weeks immediately prior to the COVID‐19 regulated lockdown in the UK, with the four weeks immediately subsequent to lockdown. [ABSTRACT FROM AUTHOR]

Patients with psychosis are a particularly vulnerable group where the widespread, unpredictable changes in the COVID‐19 situation surrounding the pandemic and subsequent lockdown are very likely to have a significant impact. Here, the authors discuss a number of patients who presented to the early intervention in psychosis team and included COVID‐19 in their psychopathology. They also consider the main clinical patterns and management messages. [ABSTRACT FROM AUTHOR]

SUMMARY: Psychiatrists live and work in complex, clinically challenging times. Their paperwork is geared increasingly towards defensive practice, key performance indicators and risk assessment forms. Somewhere in the process, detailed understanding of patient experience and clinical formulation based on key psychiatric expertise and skill in mental state examination have taken a backseat. I review the history behind the Present State Examination, the realisation in the 1980s of the need for a common psychiatric language internationally and the current position on phenomenology in psychiatry curricula in the UK. I conclude that it is time to think seriously about a return to basics in psychiatric phenomenology and psychopathology. [ABSTRACT FROM AUTHOR]

Similarities exist between our past experience of viral diseases and COVID‐19 concerning the mental health issues of sufferers of an epidemic, frontline health workers and the social and psychological impact on society. There is significant evidence that a novel illness such as COVID‐19 can cause widespread fear, panic, anxiety and xenophobia. Dr Chakraborty explores the latest literature and what it means for mental health. [ABSTRACT FROM AUTHOR]

Effective screening of referrals is key to prioritising clinical needs. Here, the authors describe their study, which evaluated how effectively a multidisciplinary team in an early intervention in psychosis community team assessed appropriate cases based on the information in the referral letter and the implications for improving the service for the future. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to determine the influence of demographic and clinical features on the likelihood of patients being discharge to primary vs secondary care. The overarching aim of this service evaluation is to assess factors affecting discharge and determine important modulators of discharge destination to inform care planning in services. Method: Clinical and demographic data were extracted from patient notes of those discharged from the Psychosis Intervention and Early Recovery (PIER) service in Leicestershire between January 2005 and December 2013. A total of 508 records were analysed and logistic regression was used to assess the impact of diagnostic, demographic and other clinical factors on the discharge destination of patients. Results: Of the 508 patients, 241 (47.44%) had been discharged to primary care and 267 (52.55%) to secondary psychiatric services. The factors which increased the likelihood of patients being discharged to secondary care were diagnoses of enduring psychoses, being referred from inpatient services and longer time spent with the PIER team. Conclusions: Diagnosis and duration of treatment were significant predictors of discharge destination. Patients with diagnoses of enduring psychotic illness, were more likely to be discharged to a secondary psychiatric service irrespective of gender, ethnicity and geographical location. These data may suggest the possibility to predict the discharge destination when patients are taken on to the caseload of an early intervention in psychosis (EIP) team and have important implications for psychoeducation, preparing the patient for future after EIP and distribution of resources. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsDiscussionIt was considered useful to describe service-users’ and staff’s experience of Adventure Therapy (AT) in an Early Intervention for Psychosis (EIP) service, exploring the impact on personal wellbeing and feasibility of use.Focus groups were conducted with 14 participants, immediately following, and three months after a four day hiking trip. Transcripts were analysed using inductive thematic analysis. Questionnaires were administered pre and post trip to describe service-users’ physical activity, recovery and personal goals.A majority of participants reported progress towards personal goals on the AT trip and improvements in confidence and connectedness. Questionnaire items did not show improvements in physical activity and recovery measures at 3- and 6-month follow-up. Four key themes emerged from the focus groups. The themes centred around the social experience of being in relation to others and a more personal emotional experience: (a) social connectedness, (b) challenging perceptions of self-capabilities, (c) positive reaction to new experiences and (d) motivation for more.AT was positively experienced by both staff and service-users. Key areas of benefit were recognised and considered for utilisation in services in different ways. Further studies are warranted exploring maintaining and supporting benefits gained following AT. [ABSTRACT FROM AUTHOR]

Background: Decades after the establishment of clear guidelines for management, mostly due to irrational approach, diarrhea is still a major concern in the developing world, including India. The scenario is even worse in urban slums owing to poor health-seeking and socio-environmental vulnerability. Determining the distribution of rational diarrhea management by practitioners and identification of its important predictors seemed urgent to minimize the potential for antibiotic resistance, diarrhea-related mortality and morbidity in these areas. Methods: Between May 2011 and January 2012, 264 consenting, randomly selected qualified and non-qualified practitioners (including pharmacists) were interviewed in the slums of Kolkata, a populous city in eastern India, regarding their characteristics, diarrhea-related knowledge (overall and in six separate domains: signs/symptoms, occurrence/spread, management, prevention/control, cholera and ORS), prescribed antibiotics, intravenous fluid (IVF) and laboratory investigations. Rationality was established based on standard textbooks. Results: Among participants, 53.03% had no medical qualifications, 6.06% were attached to Governmental hospitals, 19.32% had best knowledge regarding diarrhea. While treating diarrhea, 7.20%, 17.80% and 20.08% respectively advised antibiotics, IVF and laboratory tests rationally. Logistic regression revealed that qualified and Governmental-sector practitioners managed diarrhea more rationally. Having best diarrhea-related knowledge regarding signs/symptoms (OR=5.49, p value=0.020), occurrence/spread (OR=3.26, p value=0.035) and overall (OR=6.82, p value=0.006) were associated with rational antibiotic prescription. Rational IVF administration was associated with best knowledge regarding diarrheal signs/symptoms (OR=3.00, p value=0.017), occurrence/spread (OR=3.57, p value=0.004), prevention/control (OR=4.89, p value=0.037), ORS (OR=2.55, p value=0.029) and overall (OR=4.57, p value<0.001). Best overall (OR=2.68, p value=0.020) and cholera-related knowledge (OR=2.34, p value=0.019) were associated with rational laboratory testing strategy. Conclusion: Diarrheal management practices were unsatisfactory in urban slums where practitioners’ knowledge was a strong predictor for rational management. Interventions targeting non-qualified, independent practitioners to improve their diarrhea-related knowledge seemed to be required urgently to ensure efficient management of diarrhea in these endemic settings. [ABSTRACT FROM AUTHOR]

Delayed discharge is a significant problem in psychiatry inpatient wards. Here, Drs Smith and Chakraborty describe their survey to identify the factors influencing prolonged admissions on acute adult psychiatry wards in Leicestershire Partnership NHS Trust. [ABSTRACT FROM AUTHOR]

Better outcomes in first-episode psychosis (FEP) have been associated with lesser duration of untreated psychosis (DUP), making reduction of DUP a key target of early intervention in psychosis (EIP) services. Here, the authors examine the case records within an EIP to find out which psychiatric service had started the antipsychotic if a patient was being prescribed one, and discuss the contribution of teams other than EIP in reducing DUP. [ABSTRACT FROM AUTHOR]