To survey the effect of COVID-19 on mental health of both medical professionals and the general population, as well as attitudes surrounding the disclosure of mental illness.

An online survey comprised of two questionnaires, one for medical professionals and one for the general population, were conducted via social media. Both questionnaires asked respondents of the effect of COVID-19 on their mental health, and the former asked respondents about the effect of COVID-19 on their patient group's mental health. The questionnaires went on to ask respondents about their attitudes to mental health disclosure in various scenarios, to varying groups of people. The general population group was also asked how they would react if someone else disclosed their mental illness to them.

The questionnaire for the medical professionals gained 62 respondents and the one for the general population had 122 respondents, with responses from multiple nations. Overall, COVID-19 has affected everyone's mental health to a degree, and all groups had reservations about disclosing their mental health issues to others. The medical professionals were especially reluctant to disclose mental illness to their patients, but were more comfortable when it came to disclosing mental illness to colleagues. The general population, however, was much more reluctant to disclose mental health issues to their colleagues. The general population were, on the whole, willing to listen to and help anyone who came to them with mental health concerns. Both groups surveyed showed reluctance toward disclosure to the wider community.

COVID-19 appears to significantly affect not only physical health, but mental health as well. There is at least some degree of stigma surrounding the disclosure of mental health issues. While most would be happy to help anyone who came to them with their mental health problems, there seems to be an attitude shift when people must contend with mental health issues of their own.

To summarise the tolerability profile following an infusion of methylene blue (MB), including subjective effects on mood and energy levels and haemodynamic changes, in patients with Bipolar Affective Disorder (BPAD).

BPAD is associated with mitochondrial dysfunction and impaired cellular energy production. MB is proposed to enhance mitochondria function via rerouting electrons and intracellular reduction of oxidative stress, and is therefore a candidate compound for use as a probe to reveal alterations in brain oxygen metabolism in vivo in patients with BPAD. Although there are reports of MB used as treatment for BPAD, the tolerability and subjective effects of a single IV dose in this population has not yet been defined.

Using a single-blind, randomised, within-subject design, 7 patients with BPAD on stable pharmacological treatment and 6 healthy controls (HCs) received an infusion of 0.5mg/kg MB and a placebo glucose solution one week apart. Visual Analogue Scales (VAS) assessing ‘Mood’ and ‘Energy’ levels were completed by 11 participants, and blood pressure (BP), heart rate (HR) and any subsequent side effects were recorded before and after infusions.

A significant, albeit very small, effect of MB on ‘Mood’ levels relative to placebo was demonstrated, independent of groups (change relative to baseline: 5.5% ± 11 increase (placebo) vs -1.6 % ± 9.5 reduction (MB); p = 0.027). Although there was no effect of MB on energy levels in either group, there appeared to be a trend for a general group difference in ‘Energy’ levels across all trials, with lower ratings in BPAD patients (p = 0.058).

There was a trend for significantly lower post-infusion HR relative to pre-infusion (-6.4 ± 8.8 bpm, p = 0.07. Diastolic BP was higher (3.0 ± 7.8mmHg, p = 0.039). These effects were independent of groups and drug. The most common side effect with MB was mild/moderate pain at infusion site (n = 10/13), resolving within median 32.5 minutes (IQR 6-102), and discoloured urine in 7/13 subjects lasting median 44.5 hours (IQR 36-59). No difference in frequency of side effects reported between groups.

Although limited by small sample size, this tolerability analysis demonstrates a acceptable profile of effects of MB on subjective ratings and blood pressure, in both BPAD and HCs. Common side effects of discoloured urine and pain at infusion site are in line with previous reports in the literature. We observed a small effect of MB on mood ratings which could be related to the discomfort experienced during infusion.

To compare the MATRICS Consensus Cognitive Battery (MCCB) and a novel Virtual Reality (VR) task, called VStore, in assessing cognition and functional capacity (FC) in schizophrenia. We hypothesise that VStore reliably discriminates between patients and controls, correlates with the MCCB, and is well-tolerated. Additionally, VStore is expected to strongly correlate with FC measures.

Cognitive and functional deficits in schizophrenia have a major impact on everyday functioning of patients. The gold-standard cognitive assessment is the MCCB, while the USCD Performance-Based Skills Assessment (UPSA) is used to assess FC in this patient group. Neither of which are without limitations. For example, both take a long time to administer, and the MCCB alone cannot give clear indications of FC. We propose the use of a novel VR task to simultaneously measure cognition and FC in a single assessment. VStore is a shopping task, which involves a verbal learning task followed by buying items from a predetermined shopping list in a virtual minimarket.

Ten patients with schizophrenia or schizoaffective disorder and ten age/gender-matched healthy controls recruited from South London, completed the following assessments: VStore, MCCB, UPSA & Global Assessment of Functioning (GAF), and VR-Symptom Questionnaire (VRSQ); while controls only completed the VR task. To test whether VStore can differentiate between patients and controls we employed unpaired t-test. To explore associations between VStore Total Time, MCCB composite score and FC measures Pearson's r was used. Finally, mean differences between pre/post-VR symptoms scores were tested using paired t-test.

There was a significant difference between patients and controls on the verbal learning task (t16.38=−4.67,p < .001), and total time spent completing the VR task (t11.41 = 2.67, p = .023). In addition, VStore had a strong association with MCCB composite score (r=−.80,p = .010). While both VStore (r=−.82, p < 001) and MCCB (r = .77,p = .010) had significant correlation with the UPSA, only VStore had a significant association with the GAF (r=−.68,p = .030). Finally, VStore appears to be well-tolerated, causing no measurable side effects in the VRSQ (Pre-VR Mean =12.1[SD = 13.5], Post-VR Mean = 9.6[SD = 11.5],t9 = 0.49,p > .05).

Results suggest that VStore can discriminate between schizophrenia patients and healthy controls. In addition, VStore and MCCB seem to be strongly associated, suggesting that they tap into identical cognitive domains. VStore seems to be strongly correlated with FC, more so than the MCCB, and cause no measurable side effects. Taken together, this suggests that this novel VR task has the potential to reliably measure cognition and FC simultaneously.

The aim of this work is to gather and evaluate scientific evidence about the clinical effects of Acceptance and Commitment Therapy (ACT) in the treatment of patients with trauma-related Post-Traumatic Stress Disorder (PTSD).

A literature search was conducted on PubMed platform, starting from the following MeSH terms: “Acceptance and Commitment Therapy”, “Trauma and Stressor Related Disorders”, “Psychological Trauma”. Studies obtained were analysed, corresponding to investigations based on an adult population with trauma and stressor related disorders.

The search provided 13 results, of which 12 met the defined criteria. Different types of studies with variable samples were considered, including randomised clinical trials, longitudinal observational studies, narrative reviews and an analysis of case reports.

Globally, ACT has been showing a crescent role in the treatment of individuals with trauma histories by enhancing positive outcomes and by being associated with greater psychological flexibility. It is increasingly considered to be well-suited to the treatment of trauma by targeting avoidance, coping strategies with emotional disengagement and persistent dissociation, aspects associated with greater PTSD symptom severity and related psychopathology.

Furthermore, research suggests that acceptance-based treatments are helpful in promoting emotional, behavioural, and neural changes in psychological disorders characterised by disgust, shame and guilt that commonly co-occur with PTSD.

Among the various exposure factors, we found a growing production of recent literature in which ACT has been applied in the context of oncology life-threatening settings, demonstrating significant improvements in symptoms and quality of life, as well as reductions in emotional disturbances, physical pain and traumatic responses.

However, little is known about implementation and results of ACT in situations of trauma and psychiatric comorbidities. Data suggest that, when applied to individuals with psychosis and history of trauma, there is an improvement in overall severity and anxiety symptoms, emotion regulation strategies and a greater sense of engagement in care; nevertheless, reduction of specific trauma symptoms remains controversial. More mention is made about the growth of literature evaluating the application of ACT as a conjunctial therapeutic method for trauma and simultaneous addictive disorders.

Overall, despite limited published research currently available, some evidence starts to support ACT's promising role as an effective psychotherapeutic approach to trauma and stressor related disorders. Its application in situations where organic diseases represent stress factors has been growing. Future research should focus on clarifying the role of ACT in psychiatric comorbidity scenarios, allowing this psychotherapy to help individuals find a meaningful and valuable life beyond trauma.

Many patients with psychosis symptoms and schizophrenia use cannabis as a recreational drug. Patients who use cannabis respond differently to antipsychotic treatment compared to those who do not. Despite this, there is a lack of evidence, and therefore clinical guidance, pertaining to the best pharmacological treatment to improve psychosis or cannabis use in this population. This systematic review was carried out to assess the current evidence base regarding the most effective pharmacological treatment for patients with psychosis who also have a background of using cannabis. Our specific question was: ‘in patients with a dual diagnosis of psychosis and cannabis use, which pharmacological interventions have the most efficacy in improving psychosis or reducing cannabis use?’.

A search of EMBASE, PsychINFO, and MEDLINE(R) databases was carried out on September 30, 2020. Bibliographies of other studies were also searched for relevant articles. After exclusion of any articles which did not meet inclusion criteria for this review, eleven full texts remained; a qualitative analysis was carried out on these, but there was no meta-analysis. Only randomised control trials (RCTs) whose interventions and controls were pharmacological therapies, and which included patients with a background of cannabis use and psychosis, and which measured clinical outcomes, were included.

We found 11 articles which analysed 10 RCT studies (n = 363) investigating risperidone, olanzapine, clozapine, haloperidol, ziprasidone and imipramine. 6/11 were double blind. The studies were small in size, varied in their methodology, exact inclusion criteria, exact outcomes, and all had a high risk of bias. Few significant findings were found. There is limited evidence for clozapine having anti-craving effect however whether this is associated with reduction in use remains to be demonstrated. We found no studies of adjunctive anticonvulsant agents, which are often used in psychotic disorders.

This review underlines the paucity of studies on which to make evidence-based decisions. No new studies have been undertaken since the last systematic review in this area in the last 7 years. Due to the lack of high-quality evidence found by this review, there remains a considerable need for interventional, high-quality RCTs in this comorbid patient group.

Traumatic brain injury is a leading risk factor for degenerative conditions. Although in the past this was believed to affect mostly boxers, recent studies have expanded the at-risk population to include American football players, rugby players, hockey players and other athletes involved in contact sports. Hence, there has been growing interest in the media and the public at large on the short and long term impacts of head trauma in sportspersons. The aim of this study is provide an overview of the impact of traumatic brain injury in contact sports and the link to early onset dementia.

For the purpose of this study we conducted a literature search using PubMed electronic base and Google scholar. The search was made in February 2021 and using the following keywords ‘early onset dementia’, ‘presenile dementia’, ‘traumatic brain injury’, ‘contact sports’, ‘sportsmen’, and ‘athletes’. The search words were used individually and in combination to gather relevant articles. Types of studies included were case reports, case series, cohorts, cross-sectional, editorial and newspaper articles.

Most of the published studies have shown significant associations between repeated head trauma and brain morphological changes evidenced by the presence of myelinated axons, astrocytosis, perivascular neuroinflammation and formation of phosphorylated Tau proteinopathy. These contribute significantly to alterations in axonal functioning and synaptic transmissions which sets the stage for neuronal degeneration. These changes affect both the macroscopic and microscopic structures with consequent neurochemical disturbances and functional deficits which, manifest primarily as executive dysfunction.

Current evidence supports an association between participation in contact sports and neurodegenerative disease, despite the protective aspects of sporting activities. Overall the studies reviewed have shown that brain injury remains a potent risk factor for the early onset dementia seen in sportspersons. Consequently, it is prudent for more proactive and precautionary measures to be put in place to reduce impacts of head injury and to better identify and manage brain injury in sports.

There has been an increasing recognition of the lack of clinical validity of different types of ICD10 personality disorder.

The prevalence was established among patients in a high secure hospital in England of those with either a primary or secondary diagnosis of personality disorder and its recorded type according to ICD10 and then ICD11.

The new ICD11 classification increased the validity of diagnosis of personality disorder as well as its severity.

ICD 11 has proposed the dropping of the classification of personality disorder based on particular types of personality disorder and instead adopting a diathesis model based on 2 dimensions: presence of personality disorder and three levels of severity (Mild, Moderate and Severe) and the option of specifying one or more prominent trait domain qualifiers (Negative Affectivity, Detachment, Disinhibition, Dissociality, and Anankastia) and also specify a Borderline Pattern qualifier.

The electronic medical records were used to establish the presence and type of personality disorder using the criteria of ICD10 and ICD11.

The researchers assured reliability by rating some vignettes using the Schedule for Personality Assessment from Notes and Documents (SPAN-DOC) before rating actual cases.

From a total population of 208 patients, 64(30.8%) were classified as having either a primary or secondary diagnosis of personality disorder according to the ICD 10.

30 (47%) had dissocial personality disorder (DSPD), 19(30%) emotionally unstable personality disorder (EUPD) and 8(13%) paranoid personality disorder. 20 (31%) had a comorbid diagnosis of mental illness and about a tenth had diagnoses of multiple personality disorders. These types of personality disorder diagnosed by the researchers using ICD 10 did not always match the types of personality disorder diagnosed by clinicians at the hospital.

All patients met the criteria of personality disorder under ICD 11 but the number with a borderline specifier was greater than those with an ICD10 diagnosis of EUPD. Using the trait domain qualifiers in ICD 11, patients with ICD 10 diagnoses of EUPD or DSPD showed dissociation and disinhibition, with those with a DSPD showing low and those with EUPD high negative affectivity.

The results confirm that while psychiatrists in a high secure hospital reliably diagnose the presence of a personality disorder, they are much less able to make an accurate diagnosis as to the actual type of personality disorder. The new ICD 11 classification will increase the clinical validity of the diagnosis of personality disorder and its severity.

Electronic medical case files of male prisoners in a category B prison in London was studied to establish a prevalence during an 8-month period of the use of and the reasons for prescribing gabapentinoids in prison.

In addition, the prevalence of co-prescription of gabapentinoids with opioids and antidepressants was also assessed in light of the increased risk of respiratory depression resulting in death when these drugs are used in combination.

A retrospective, SystmOne electronic case-file based survey was undertaken searching by SNOMED CT supplemented by examination of free text, in a category B prison for males (Capacity 1500 prisoners; Average turnover of prisoners up to 6000 per year), including to establish practice standards related to the prescription of Gabapentinoids in the prison and determine the compliance with these.

In total, 109 cases were identified of prisoners having been prescribed gabapentinoids, pregabalin in 66 cases (61 per cent) and gabapentin in 43 cases (39 per cent). In 36 cases (33 per cent) prescriptions were for unlicensed indications. This in fact represented 50 per cent of the cases where the indications were documented. Half of the cases were co-prescribed gabapentinoids with an opioid substitute and 17% with antidepressants. Only in 22% of the cases there was documentation of discussion with the prisoner about the potential risks of co-prescribing with these medications. In 14 cases (13 per cent), prescribed gabapentinoids were diverted to other prisoners.

For those prescribed gabapentinoids in prison, the indications for such use especially if off label should be reviewed and their use minimised where relevant.

The initiation of gabapentinoids in prison should be avoided.

For patients who are also receiving antidepressants and opioid substitutes or are abusing opiates, consideration should be given as to whether it is safe to continue on gabapentinoids, given the risks of misuse and death.

Issues raised by this study are likely to apply to other prisons, secure forensic psychiatric facilities and indeed community mental health and primary care as well.

From 1 April 2019, gabapentinoids have been classed as Class C controlled drugs in the UK.

The aim is to tap into user experience in the UK and to analyse what lessons can be learnt from those who have recovered from alcohol dependence to help those who are struggling including to inform the delivery of alcohol services.

The study was conducted in London, UK. 20 males in the age group 30–45 years were recruited. 10 of these participants had recovered from alcohol dependence and the other 10 were in treatment for alcohol dependency and diagnosed as dependent according to ICD-10 or DSM 5 criteria. In the former group, each participant had at least 2 years of complete sobriety. A semi structured questionnaire was developed and used to interview all the subjects.

Males 30-45 years were eligible as alcohol dependence is more common in this age group and purposive sampling drove the selection (i.e. if early analysis suggests the importance of a particular factor, subjects likely not to show that factor would be sampled for comparison).

Grounded analysis was the qualitative analysis method of choice and constant comparison was used, i.e., data were collected and analysed concurrently.

The main “families” that arose grouped around relationships in both the recovered alcoholics (RA) and continued alcoholics (CA). A successful shift required a change in the relationship to self, from feeling empty or critical towards acceptance and this shift was facilitated by being accepted and respected by others.

Relationship as motivator to stop drinking

24% people had the insight to self-refer to voluntary organisations such as AA but 76% did so because of fear of losing either their relationship or their job.

Although 80% of recovered alcoholics had been ambivalent about coming off alcohol, the shift happened when they had a nurturing relationship elsewhere such as a key worker at the Alcoholics Anonymous.

Insight and Perception

Awareness of alcohol as an obstacle rather than a solution was key for change to occur. Although 75% people with insight into their difficulties were more successful in maintaining sobriety, insight alone without action was insufficient. Moreover, action was possible without insight. Fear of death alone was a sufficient motivator.

Difference between support systems

As a result of comparing those patients with alcohol dependence who responded well to treatment compared to those who were very recalcitrant to treatment important characteristics of an effective service have been identified. It was clear that the quality of services offered to those with alcohol dependence who attended A&E departments could be improved by offering more time for the initial assessments and adopting a more individualistic approach for each patient.

Training sessions to the A&E staff about the differences required in management between those with alcohol dependence who are motivated to abstain compared to those who will only be able to reduce consumption should be offered rather than mere blanket exhortations to abstain from alcohol consumption. The importance of behavioural avoidance of situations where alcohol is excessively consumed is more helpful in terms of eventual outcome.

The A&E staff should be encouraged to employ individuals from Alcoholics Anonymous in their department as early involvement with AA improves engagement and outcome can greatly improve engagement with treatment programs subsequently and lead to significantly better outcomes.

To determine the prevalence of depression among antenatal mothers in two tertiary care maternity hospitals in Colombo and associated factors of antenatal depression.

A descriptive cross-sectional study was conducted in antenatal clinics in two tertiary care maternity hospitals in Sri Lanka. Every second woman attending the clinic was recruited using systematic sampling until the calculated sample size was obtained. A structured questionnaire and Edinburgh Postnatal Depression Scale (EPDS) were used for data collection. Data were analysed using SPSS.

A total of 536 pregnant women were participated in the study. Around one third (180, 33.6%) of pregnant women had depression according to the EPDS score (Mean = 7.66, SD = 5.17). The mean age was 29.65(SD = 9.30) years and among them 387(74.3%) had at least secondary education. The majority lived with parents or in-laws (329, 61.4%) in addition to nuclear family members and 266(49.6%) were in their third trimester. Most women were in first pregnancy (149, 39.5%) and 11 (2.1%) had a history of psychiatric illness. Sixty (11.2%) women and 156(29.1%) of partners used psychoactive substances. Verbal abuse and physical abuse were reported by 5(0.9%) and 3(0.6%) respectively. Sixty one (11.4%) women have reported inadequate family support, and 226 (42.2%) had only support of the partner. Among them 346 (64.6%) reported excellent support from partner. One third (186, 34.7%) of pregnancies were unplanned, 328(61.2%) women reported a very good relationship with their partner. Complications were experienced by 123(22.9%) of women during this pregnancy and commonest was gestational diabetes. The presence of depression was significantly associated with living with extended family (p = 0.033) and in-laws(p = 0.014). Multi parity (>2 children) (p = 0.008), partner's substance use (p = 0.002), inadequate family support (p = 0.024), inadequate partner's support (p = 0.003), unsatisfactory relationship with partner (p = 0.000) and unplanned pregnancies (p = 0.001) were also associated with depression. Logistic regression analysis indicated a significant association between depression with partner's substance use, unavailability of family support and poor relationship with the partner.

Around one-third of mothers were having antenatal depression. Several spouse related factors and unsatisfactory family support were associated with depression among antenatal mothers.

The aim of this study was to describe and compare the mental health status of doctors and medical undergraduates in selected institutions during COVID-19 pandemic.

A cross-sectional analytical study was conducted among doctors working in major tertiary care hospitals two of which, risk is unpredictable and high, the other where all patients are positive for COVID-19 and among medical undergraduates. The doctors were selected using disproportionate stratified sampling and medical undergraduates using stratified cluster sampling. Data were gathered using a Google form containing socio-demographic details, perception on the pandemic and the General Health Questionnaire-12(GHQ-12).

There were 468 participants in the study and among them 243(51.9%) were doctors. Mean age of the doctors’ is 34.54(SD = 7.43) years and more than half (50.06%) were in post graduate training. Majority were worried about their health (65%) and their loved one's health (90.1%). Among doctors 220(90.5%) felt that they have moderate or higher risk of acquiring COVID-19 and 15.6% would not have worked due to the risk. According to GHQ-12, 182(74%) doctors were psychologically distressed (mean GHQ = 12.64, SD = 4.54) and it was significantly associated with age less than 35 years (p = 0.039) and worry about interruption of their daily routines(p = 0.010).

The mean age of 225 medical undergraduates was 25.20 (SD = 1.34) years and 176(78.2%) of the participants were psychologically distressed (mean GHQ = 14.32, SD = 6.67). Majority (59.11%) believed that they are at high risk of getting COVID-19. Their distress was significantly associated with the worry about the impact of COVID-19 related restrictions on their daily routines (p = 0.000).

Binomial logistic regression confirmed that doctors were distressed due to impact on their income whereas both doctors and medical undergraduates were distressed due to impact on daily routines.

Nearly three quarter of both doctors and medical undergraduates were psychologically distressed during COVID-19 pandemic. The worry was due to contracting illness, financial issues and the COVID-19 regulations.

The study describes the prevalence and associated socio-demographic variables of psychoactive substance use among male supportive staff members at a tertiary care hospital in Sri Lanka.

A cross-sectional descriptive study was carried out among male supportive staff members of a tertiary care hospital in Colombo District, Sri Lanka by using a self-administered anonymous questionnaire. Participants were recruited using stratified cluster sampling in thirteen overseer divisions of the hospital. Anonymous questionnaires were collected into a sealed box and analysed using Statistical Package for Social Sciences 20.

The mean age of the 404 male staff members who participated in the study was 38.78(SD = 10.90) years and 71.5% were married. Among them 202 (49.1%) were educated up to grade 6-11 and 30 of them has had encounters with law in the past. Thirty of participants had history of psychoactive substance use in the family. Alcohol was used more than once a month by 127(30.9%) and more than once a week by 19(4.6%) individuals. Among other substances, tobacco, beetle and beedi were used by 104(25.3%), 78(19.0%) and 18(4.4%) respectively at least once a month. Further, 22(5.3%), 20(4.8%), 7(1.7%) and 7(1.7%) participants used Mava, Cannabis, Methamphetamine and Thool respectively at least less than once a month. Heroin, Tramadol and Morphine were used by two individuals at least less than once a month. Among substance using participants, 132 wished to cut down their habit. Most commonly identified (14.1%) adverse consequence was financial issues secondary to psychoactive substance use. Eleven (4.5%) staff members used the substance at hospital. Alcohol use was associated with age more than 35 years (p = 0.039) and history of forensic involvement (p = 0.038). Tobacco(p = 0.000), beetle (p = 0.056), Cannabis (p = 0.000) and mava (p = 0.015) use were significantly associated with positive forensic history. Supportive staff members’ alcohol and cannabis use was associated with tobacco (p = 0.000, p = 0.000) and beetle use (p = 0.001, p = 0.049). Mava use was associated with alcohol (p = 0.060) use in addition to tobacco (p = 0.020) and beetle use (p = 0.008).

Binomial logistic regression revealed alcohol use and beetle use were associated with the number of children in family and above associations.

Commonest psychoactive substance consumed by supportive staff members were alcohol, tobacco, beetle, Cannabis and Mava in descending order of frequency. Forensic history was significantly associated with substance use. True prevalence of substance use can be higher than these values.

The aims of this project were to assess how well the Netflix drama 13 Reasons Why portrayed suicide, in terms of both accuracy and safety, and to discuss the potential effect this could have on viewers.

Psychiatric content within dramatic media can have measurable effects on the population, such as reinforcing stigma around mental illness. Given the show's focus on a character's suicide, the most serious effect here would be suicide contagion.

Guidelines and regulations for the portrayal of suicide in media are in place to protect those who might be vulnerable to suicide contagion.

We formed our own pro-forma of 42 criteria using existing guidelines written for both news and dramatic media. These criteria were formatted into positive and negative pairs; positive being instances of guidelines being followed, negative as guidelines being broken. These were further organised into 7 categories.

Each episode of seasons 1-2 was then assessed against the criteria. Cumulative instances of guidelines being followed or broken were compared within and between seasons. Context of each instance was taken into account by the primary researcher, and we also highlighted instances of exceptional breach of these guidelines.

The results showed an over-all breach of the guidelines, with no significant improvement between the seasons. Some categories of criteria, such as “asking for help” and “mental health”, were portrayed well overall. Other categories, such as “blame”, performed extremely badly.

The most significant breach was the graphic suicide scene at the end of the first season, which completely disregarded Samaritans’ guidelines.

The breaching of guidelines in this show was overwhelming. In terms of severity, although there were some positive themes running through the seasons, there were also worrying instances of guidelines being completely disregarded. This led to the conclusion that the producers of the show did not take their responsibility to young, vulnerable viewers seriously regarding the dangers around portraying suicide.

Suggestions from this study are that more guidelines around suicide are needed specifically for dramatic media, and that existing guidelines should be conflated and have stronger implementation by regulators. This implementation should potentially include overseas providers such as Netflix. Ethically, a significant challenge here is maintaining balance between safety and allowing artistic licence.

With the advent of the COVID-19 Pandemic the NHS long term Plan commitments of January 2019 to improve crisis care nationwide became all the more pressing. The aim of this study was to thematically investigate what mental health crisis presentations might be diverted from the Emergency department to external crisis hubs in order to reduce the COVID-19 contamination risks.

All referrals made to the Homerton University Hospital (HUH) mental health liaison service were looked at between 1/3/20-11/6/20 (n = 846), coinciding with the first peak of the COVID-19 Pandemic.

Referral data was anonymised and sorted independently into naturally emerging thematic classes by two junior liaison doctors.

Cases that did not clearly fit any of the 14 themes generated were further looked into to determine outcome of referral and discussed to try and match to an appropriate class.

14 frequent themes for mental health crisis referrals were identified. The distribution of these ranged from most common (suicidality) to neurocognitive presentation and identified shifts in themes over the course of the pandemic peak such as increases of low mood, anxiety and intoxication requiring medical attention over the three month period.

Although themes for presentations may be identified in acute referrals to mental health liaison services it is problematic determining how these may be parsed safely to crisis hubs without risking overlooking cases that may require medical attention. The most common theme that was identified and remained throughout the first wave of the COVID-19 Pandemic was acute suicidal presentation. The remaining themes would require careful consideration around risk thresholds for what a service may wish to accept in devolving the emergency department liaison and balance these against future risks of repeat COVID-19 waves.

Risk assessment and management are crucial elements of clinical practice in mental health. Healthcare Improvement Scotland identified risk management as a key area for change, with risk tools identified as one necessary component. In NHS Greater Glasgow and Clyde (GG&C) the CRAFT tool replaced the Glasgow Risk Screen (GRS) in October 2019. The CRAFT tool is a 2 page document that comprises a broad risk screen, details of historical risk events and prompts for family and carer involvement. The aim of this study was to assess staff attitudes to the CRAFT, 12 months after it had been rolled out. Looking at whether the CRAFT tool is used to inform decision making about risk in clinical settings and if patients were involved in the risk management process.

An electronic staff survey was distributed to all clinical staff within NHS GG&C Mental Health Services. Clinical staff includes the following professional groups: Medical, Nursing, Psychology, Occupational Therapists and Allied Health Professionals. Contact details were accessed via the relevant managers and surveys were sent via secure global address lists. Questions were focused around the following areas: time taken to complete/update/frequency of use/contact and ease of use, role in decision making, patient and carer involvement/knowledge, view on the impact of the CRAFT.

There were 209 responses. This represents a response rate of approximately 10%. 89% of respondents had completed a CRAFT tool at some point but only 38% had received training. 15% reported that the CRAFT did not aid decision making about risk in clinical settings, whereas 37% said it did and 42% said it did sometimes. 46% report patients are consulted most of the time (34%) or always (12%). The qualitative impression was that the CRAFT was an improvement on its predecessor. However common themes from responders highlighted a lack of clinical relevance or impact decision making, lack of training in filling it out and cumbersome integration with the electronic case notes.

Staff perceptions of the CRAFT tool were generally negative with many feeling it was a box ticking exercise that had minimal real world impact on patient risk and its management. However many felt it was an improvement over the previous risk tool and the majority used it at some point to aid clinical decision making.

To describe the occurrence of medical comorbity in patients with neurodevelopmental disorders presenting to the Adult Neurodevelopmental Service (ANDS) multi-disciplinary new case clinic at the Institute of Mental Health (IMH) in Singapore. We hypothesize that patients with neurodevelopmental disorders have higher rates of medical comorbidity compared to those without a diagnosis of neurodevelopmental disorder.

Medical comorbidities are common in patients with neurodevelopmental disorders. They may have difficulties managing their medical conditions which could in turn affect their well being, quality of life and life expectancy.

A retrospective cohort study was conducted amongst patients who presented to the clinic from January 2015 to December 2016. The electronic case records of the assessments were de-identified and the medical conditions of patients were collected and analysed.

319 patients attended the ANDS new case clinic in the 2-year study period. 87.1% (278/319) were diagnosed with a neurodevelopmental disorder while 12.9% (41/319) did not receive any diagnosis of a neurodevelopmental disorder.

58.3% (162/278) of patients with a neurodevelopmental disorder had at least 1 medical comorbidity while only 31.7% (13/41) of patients with no neurodevelopmental disorder had at least 1 medical condition.

Patients with neurodevelopmental disorders had higher rates of epilepsy (12.2% vs 4.9%), cerebral palsy (3.2% vs 0%) but lower rates of having other neurological conditions (1.4% vs 7.3%) compared to those with no neurodevelopmental disorders.

Patients with neurodevelopmental disorders had higher rates of diabetes (6.1% vs 2.4%), hypertension (6.1% vs 2.4%), hyperlipidaemia (7.1% vs 2.4%) and cardiovascular conditions (2.9% vs 0%) than those without a neurodevelopmental disorder.

In terms of other medical comorbidities, patients with neurodevelopmental disorders had higher rates of thyroid abnormalities (4.7% vs 2.4%), respiratory problems (7.6% vs 2.4%), musculoskeletal conditions (5.8% vs 0%), eye issues (5% vs 2.4%) and hearing problems (2.9% vs 0%) but similar rates of dermatological conditions (10.1% vs 9.8%) and gastrointestinal conditions (4.7% vs 4.9%) compared to those with no neurodevelopmental disorders.

Patients with neurodevelopmental disorders have significantly highly rates of medical comorbidity than those without any neurodevelopmental disorders. This study highlights the need to raise awareness of the common medical comorbidities in patients with neurodevelopmental disorders and to ensure adequate screening and referral for follow-up medical care for them.

This reel analysis identifies quotes and actions of fictional characters from TV shows, namely: Hercules Poirot, Sherlock Holmes and House who can demonstrate learning points for clinical students to use within real psychiatric practice, using scientific theories such as the Hypothetico-deductive model, Empirical falsification and Occam's razor. This analysis explores what an ideal psychiatric interview consists of and what can be learnt from these characters and implemented within medical education.

Each show was watched by one researcher over the period of March to August 2020. The researcher noted insightful quotes which were relevant to one of the three philosophical theories. Quotes were included if they demonstrated deduction skills, revealed a character's ethos and supported the Calgary-Cambridge model of interviewing such as building rapport. 32 quotations were collected in total and narrowed to 6 quotations. These were then analysed, learning points were made and linked to the Calgary Cambridge model.

Dr House demonstrates objectivity when taking a patient's history. He utilises empirical falsification when diagnosing to avoid missing a differential diagnosis. Detective Poirot displays how empathic listening allows disclosure of details in the history, which would have otherwise been omitted. Additionally, he illustrates the importance of collateral interviewing which allows one to identify misinterpretations and inconsistencies. Sherlock teaches us the importance of perception regarding mismatching information which can help to gather new facts. All three characters interview beginning with open questions to more closed questions, supplementing with deductive reasoning in order to solve cases. Objectivity, empirical falsification, empathetic listening and deductive reasoning are the key skills displayed by these characters, that medical students can most use in their own practices.

The perfect interview discovers new information through synchronised collaboration, whilst adhering to the Hypothetico-deductive model of thought. A combination of the Calgary-Cambridge model of interviewing and skillset of the TV characters should be considered for implementation in some aspects of psychiatric interviewing. Medical education can utilise these TV shows to teach students how to conduct history-taking.

Psychosis research has largely focused on symptoms which are easier to define. Symptoms which are challenging to detect and articulate, including disturbances in the basic- and bodily-self, may not be volunteered by patients, despite causing significant distress. Increased understanding of such symptoms, which may present in the prodromal phase of psychosis and persist following the remission of positive symptoms, may allow patients who experience these to be better supported.

This study aims to explore how disturbances in the basic- and bodily-self relate to multimodal hallucinations. Through sampling a non-clinical population, this study takes the continuum approach to psychosis, where individuals experience sub-clinical psychotic symptoms which do not cause distress or functional impairment.

It is hypothesised that individuals with greater hallucination proneness will exhibit greater severity of ambiguous and imprecise mapping of bodily experiences, and will report greater levels of basic and bodily-self disturbance. This project also aims to evaluate Audiograph as a newly developed tool for creating representations of visual hallucinations.

This is a two-stage cross-sectional study. In stage one, participants completed the Multi-Modality Unusual Sensory Experiences Questionnaire to assess hallucination-proneness. In stage two, all participants were invited to complete seven further validated questionnaires which assessed basic- and bodily self-disturbances alongside co-variates including anxiety and depression symptoms, delusion-proneness and loneliness. Participants also completed emBODY, a computer-based task which allows participants to map the bodily sensations they experience during 13 different emotional states. Participants with high-hallucination proneness also completed the Audiograph task. Hierarchical linear regression, conducted using Stata, will be used to model the influence of hallucination proneness on measures of basic- and bodily-self disturbance. MATLAB will be used to generate topographical maps of the data from emBODY; maps will be compared between different emotional states using linear discriminant analysis, and between high and low hallucination proneness groups using Spearman's test.

Currently, 50 of the 104 stage one participants have completed stage two.

Since this project comprises a compulsory component of the presenting author's intercalated degree, data collection will cease on the 29th of March in advance of their poster and write-up submission deadlines in May.

Although basic- and bodily-self disturbances have been assessed in previous studies using various techniques, no single study has assessed these alongside multimodal hallucinations to link these concepts together as a whole, especially not in a general population sample. The added value of this project is to precisely address this gap in knowledge.

This systematic review aims to evaluate the effect of nicotine replacement therapies (NRTs) on measures of agitation amongst nicotine-dependent adult psychiatric inpatients.

Since the introduction of the smoke-free policy for all psychiatric facilities, a psychiatric admission is likely to upset a nicotine-dependent individual's normal routine of nicotine consumption. In addition to the physiological effects of nicotine withdrawal (NW), the interpersonal dynamic which nurse-led guardianship of nicotine products constructs presents stressors to the nicotine dependent patient.

Several systematic reviews evaluating changes in objective measures of agitation amongst smoking patients in medical critical care units have found varied results, with some demonstrating worsening agitation with NRT use. We therefore believe that there is sufficient equipoise in the use of NRT to prompt a review of studies amongst psychiatric inpatients.

This review identified English language studies through developed search strategies in PubMed/MEDLINE, EMBASE, PyschINFO, PSYCHLit, Cochrane databases, and Google scholar. The bibliographies of notable papers were explored. Hand searches of five major psychiatric journals were conducted. Peer reviewed studies of any study design were included if they reported primary data of adult psychiatric inpatients. Studies were extracted from 1990 – present, this was felt appropriate as nicotine replacement patches became available in 1992.

Search strategies were informed by MeSH search terms and included multiple conceptions of “agitation”, including variations on; agitation, irritability, and arousal to capture the concept from broad academic constructions. The quality of studies was assessed with the Newcastle-Ottawa and Cochrane Collaboration tools.

This review follows PRISMA guidelines, and an application for PROSPERO registration has been submitted pending acceptance.

Two studies were identified which matched inclusion criteria. A double-blinded randomised placebo-controlled trial of 40 nicotine-dependent inpatients from Allen et al. reported a significant 23% reduction in Agitated Behaviour Scores at 24 hours following NRT administration on admission compared to their matched placebo controls. Yet a retrospective cross-sectional analysis from Okoli using scores for NW identified more severe withdrawal symptoms including “restlessness” and “anger/irritability” than nicotine-dependent patients not provided with NRT.

Despite considerable commentary within literature there is presently only one study providing moderate evidence of a positive benefit to measures of agitated behaviour from the use of NRT amongst nicotine-dependent psychiatric inpatients. There is currently very low evidence whether NRT improves or exacerbates the agitation associated with NW amongst nicotine-dependent psychiatric inpatients.

Opioid dependence has high risks. Opioid substitution treatment (OST) improves outcomes. Addiction specialist prescribers prescribe OST and monitor safety, but nonattendance may lead to worse outcomes. Telemedicine can reduce travel and improve attendance at appointments. Before COVID-19, we started a telemedicine in addictions trial to see if this helped in addictions. We present the qualitative patient and staff experience results.

Health Research Authority approval for randomized controlled feasibility trial of Telemedicine versus Face-to-Face (control) consultations at community addictions semirural service (2500km2) using a modified Hub-and-Spoke (outreach) model. Adult opioid dependent patients prescribed OST and attending outreach were recruited. Participants received two appointments in randomized group. Telemedicine was delivered using Skype-for-business videoconferencing. Patients attended outreach, saw keyworker for drug testing first, and telemedicine conducted via keyworker's laptop. Addiction prescribers located remotely at Hub. Post-trial research interview conducted assessing patient and staff experience of Telemedicine versus Face-to-Face consultations. Data transcribed, inputted to RedCap Cloud and free-text analysed using qualitative thematic analysis.

Of fifty-nine patient participants, 58 completed a research interview. Patient participants reported similar levels of satisfaction between the Telemedicine and Face to Face groups. The themes generated in relation to Face-to-Face were no difference, easy, kind staff and liking being part of research. For Telemedicine, themes were less travel, good experience, easier to access, good communication, saves time and saves money. For instance, one patient stated ‘Clear, easy to access less travel’ and another patient stated ‘I struggle with travel. I found it easier’. Of 19 staff participant research interviews completed, Staff reported Good or Very Good experience with telemedicine which was equivalent for Face-to-Face consultations. Eleven staff had experience of telemedicine consultations during the trial. They reported similar themes to patients with telemedicine leading to less travel, beneficial to patient care, improves attendance and was innovative technology. One staff member reported satisfaction with telemedicine due to ‘Time, travel and money reduction’. When questioned on the downsides to telemedicine, technological issues were mainly related to connection issues and sound issues.

In the first known RCT of Telemedicine versus Face-to-Face consultations for patients with opioid dependence attending prescriber review, we found that both patients and staff were satisfied with telemedicine as compared to face-to-face consultations. Overall themes were reduced travel, saving time and more convenience. This will be very important given the impact of COVID-19 on access to addictions services.

Financial Sponsorship

East Riding CCG

Academic Health Science Network