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Purpose The purpose of this paper is to report findings from a service evaluation undertaken within a single specialist child and adolescent mental health service (CAMHS) team. The team works closely with local authority children’s services to serve specific populations recognised as experiencing higher levels of mental health need, including children living in alternative care and with adoptive families. The evaluation sought to better understand the experience of this provision during the COVID-19 pandemic and concomitant increase in remote and digitally mediated care delivery. Design/methodology/approach Analysis of the accounts of 38 parents, carers and professionals involved with the team gathered via telephone interviews and email and postal questionnaires. Findings Similar views were expressed from participants involved with the team before and following the onset of the pandemic. Overall, satisfaction was high; however, changes in care appeared more challenging for those already involved with the team before the pandemic. Differences in experience between groups were also evident. Whereas foster carers’ accounts were generally appreciative of the involvement of clinicians, particularly regarding clinician–patient relationships, amongst adoptive parents and members of children’s birth families there were more mixed and negative impressions. Originality/value Locally based service evaluations can help inform care pathway planning in specialist CAMHS provision as part of wider quality improvement initiatives. This is especially relevant considering the repercussions of the COVID-19 pandemic and as the longer-term acceptability of remote working practices is appraised.

The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.

The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.

AimsWithin the United Kingdom, there has been differential attainment in academic performance and career progression between International Medical graduates (IMG) and UK medical school graduates. Reasons reported for these differences include; poor relationships with trainers, cultural differences, and inadequate support. To close this differential attainment, effective interventions to support IMGs are indicated. This need for diversity led to the creation of the Association of Black Psychiatrists-UK Tutorial group (The-Tutors). The Tutors is a free online CASC preparatory group that started about 2-years ago and is tailored to meet the specific needs of black doctors sitting the Royal College of Psychiatrists examination. over 100-black Doctors have benefited from the group. This study was conducted to evaluate the experience of these doctors.MethodsThe sampling frame was the population of doctors who attended The-Tutors before sitting the CASC examination. Data were collected on socio-demographic characteristics, past psychiatry training experiences, and participants' experience toward preparation and passing CASC.An online questionnaire was completed and this was distributed through social media (closed WhatsApp groups).Responses were anonymous.ResultsTotal participants were 33, out of which 20 (60.6%) had passed the CASC examination while 13 (39.4%) are still awaiting results.The majority (51.5%) of the participants had only international training in Psychiatry, 27.3% had their training in the UK, and 12.1% had both, while 9.1% had no formal-psychiatric training.Most 21(63.6%) participants indicated that the group was ‘extremely useful’ for CASC preparation.In terms of comparing experience in this group with other CASC preparatory groups, all the respondents found The Tutors group more helpful; 16(48.5%) indicated that the group was ‘extremely helpful’, 14(42.4%) ‘very helpful’ and 9.1% “moderately helpful”.Most of the participants (75.8%) indicated that they were “extremely likely” to recommend the group to others.The majority (>65%) of respondents reported that The-Tutors helped in improving their knowledge, communication skills, confidence approaching the examination, and motivation to study.Close to half (48.5%) of participants who had passed the CASC examination indicated that The-Tutor was “extremely helpful” toward their success.ConclusionThis study has shown positive experiences of IMG especially of Black ethnic group attending an all- Black-led CASC preparatory group. This could be an indication that support groups specifically targeted toward the needs of IMG could help lead to an increase in success rates in UK examinations.

As the COVID-19 virus continues to ravage the world, with visible and long-lasting impacts on individuals and peoples across society, there has been another invisible, quietly spreading, threat to ...

AimsTo determine the relationship between bullying victimization and PTSD among students attending public Junior Secondary Schools in Abeokuta. The Prevalence of Bullying victimization and PTSD as well as some socio-demographic correlates were also assessed.MethodAbout 411 junior students from five randomly selected public secondary schools were approached for the study and given consent forms to take home to their parents/guardians. Those who subsequently returned signed consent forms and who gave assent to participate in the study were administered the Socio-demographic questionnaire and the Multidimensional Peer Victimisation Scale (MDPVS). They were thereafter interviewed with the PTSD module of the MINI KID.ResultA total of 351 students completed the study to yield a response rate of 85.4%. The age range of the respondents was 9–17 years with mean (SD) of 12.48 (1.50) years. The gender distribution was 49.3% males and 50.7% females. 68.7% of the respondents were from a monogamous home, 22.2% had divorced parents, 74.3% lived with both parents, and 6% reported being an only child. 14.8% of the respondents reported having experienced higher levels (moderate & high) of victimization by peers. The mean score of the overall bullying victimization level was 9.6 (±6.5). Verbal victimization subscale had the highest mean score of 3.2 (±2.0), while physical victimization had the lowest mean of 1.9 (±2.1). Seventy (19.9%) students admitted to the experience of a significant traumatic event, with only 7.1% of these meeting the current diagnosis of PTSD in the past month. There was no statistically significant association between bullying victimization and PTSD (χ2 = 2.666; df = 2; p = 0.261). Traumatic event experience was however significantly associated with high levels of bullying victimization experience (χ2 = 4.266; p = 0.039). None of the assessed socio-demographic, familial or self-perceptual factors was found to be significantly associated with either bullying victimization or PTSD.ConclusionThe experience of bullying victimization among secondary school students remains a prevailing problem in our local setting, as it is across the globe. Verbal bullying is the most common while physical bullying is the least common peer victimization experience in this study. The study points out that PTSD among high school students in our environment may be more prevalent than had previously been reported. Given the high rates of peer victimization experiences reported by students, there is a need for policy changes to make the school environment safer for students, thereby promoting their mental health.

In both clinical practice and research, focus has gradually shifted in the past decade from clinical psychosis to recognition of attenuated psychosis syndromes and the development of interventions which can prevent or mitigate transition from prodromal states to the clinical end of the spectrum. The attenuated psychosis syndromes (APS) is an entity in DSM-5 characterized by the presence of delusions, hallucinations, or disorganized speech in an attenuated form not better explained by another DSM-5 diagnosis. There is a dearth of literature on the APS in African populations, with a search of existing literature revealing no definitive prevalence study. However, in a Nigerian sample, as much as one in five adolescent students screened positive for APS. Nevertheless, a shortage of specialized services, pervasive stigma, and a preference for alternative pathways to care have militated against adequate care of adolescents with APS. Very few assessment tools have been validated for use in African populations, and intervention strategies are hampered by a shortage of trained personnel. An illustrative case is presented of an adolescent whose initial presentation was in keeping with APS but thereafter progressed to clinical psychosis. The case highlights aspects of presentation in a specialized service in Nigeria, as well as some of the problems and prospects in management of such cases.

Objective: This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents.Method: Students (n = 508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student.Results: The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174–0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain.Conclusion: The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence.