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Bebbington E, Kakola M, Nagaraj S, Guruswamy S, McPhillips R, Majgi SM, Rajendra R, Krishna M, Poole R, Robinson C. Development of an electronic burns register: Digitisation of routinely collected hospital data for global burns surveillance. Burns 2024; 50:395-404. [PMID: 38172021 DOI: 10.1016/j.burns.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/05/2023] [Accepted: 08/10/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Burn registers provide important data that can track injury trends and evaluate services. Burn registers are concentrated in high-income countries, but most burn injuries occur in low- and middle-income countries where surveillance data are limited. Injury surveillance guidance recommends utilisation of existing routinely collected data where data quality is adequate, but there is a lack of guidance on how to achieve this. Our aim was to develop a rigorous and reproducible method to establish an electronic burn register from existing routinely collected data that can be implemented in low resource settings. METHODS Data quality of handwritten routinely collected records (register books) from a tertiary government hospital burn unit in Mysore, India was assessed prior to digitisation. Process mapping was conducted for burn patient presentations. Register and casualty records were compared to assess the case ascertainment rate. Register books from February 2016 to February 2022 were scanned and anonymised. Scans were quality checked and stored securely. An online data entry form was developed. All data underwent double verification. RESULTS Process mapping suggested data were reliable, and case ascertainment was 95%. 1930 presentations were recorded in the registers, representing 0.84% of hospital all-cause admissions. 388 pages were scanned with 4.4% requiring rescanning due to quality problems. Two-step verification estimated there to be errors remaining in 0.06% of fields following data entry. CONCLUSION We have described, using the example of a newly established electronic register in India, methods to assess the suitability and reliability of existing routinely collected data for surveillance purposes, to digitise handwritten data, and to quantify error during the digitisation process. The methods are likely to be of particular interest to burn units in countries with no active national burns register. We strongly recommend mobilisation of resources for digitisation of existing high quality routinely collected data as an important step towards developing burn surveillance systems in low resource settings.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK.
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Mysore Medical College and Research Institute, KR hospital, Irwin Road, Mysuru, Karnataka 570001, India
| | - Santhosh Nagaraj
- South Asia Self-harm Initiative, JSS Hospital, Mahatma Gandhi Road, Mysuru, Karnataka 570004, India
| | - Sathish Guruswamy
- South Asia Self-harm Initiative, JSS Hospital, Mahatma Gandhi Road, Mysuru, Karnataka 570004, India
| | - Rebecca McPhillips
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
| | - Sumanth Mallikarjuna Majgi
- Department of Community Medicine, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India
| | - Rajagopal Rajendra
- Department of Psychiatry, Mysore Medical College and Research Institute, Mysuru, Karnataka 570001, India
| | - Murali Krishna
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Rob Poole
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham, LL13 7YP, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, Faculty of Biology, Medicine and Health, Ellen Wilkinson Building, Oxford Road, Manchester M13 9PL, UK
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Bebbington E, Ramesh P, McPhillips R, Bibi F, Khan M, Kakola M, Poole R, Robinson C. Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: Results from a systematic scoping review. Burns 2024; 50:302-314. [PMID: 37985272 DOI: 10.1016/j.burns.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION A key component in the classification of all injury types is to differentiate whether the injury was deliberately inflicted and by whom, commonly known as "intent" in the surveillance literature. These data guide patient care and inform surveillance strategies. South Asia is believed to have the greatest number of intentional burn injuries, but national surveillance data is not disaggregated by injury intent. Scientific literature can be used for injury surveillance where national data collection does not exist. In order to synthesise research findings, it is essential to assess the potential impact of misclassification bias. We therefore conducted a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. METHODS We followed the methods in our registered protocol (https://doi.org/10.17605/OSF.IO/DCYNQ). Studies met defined population, concept, context, and study design criteria. The databases Embase, MEDLINE, CINAHL, PsycInfo, and PakMediNet were searched. Two reviewers independently screened results. Data were extracted in a standardised manner and verified. The rigour of the method used to differentiate injury intent was appraised. RESULTS 1435 articles were screened. Of these, 89 met our inclusion criteria. Most articles were from India and Pakistan, and used an observational study design. There were 14 stem terms used in the articles. The most common was "cause". There were 40 classifier terms. The most common were "accident", "suicide", and "homicide". Few articles defined these terms. The method used to differentiate injury intent was only described explicitly in 17% of articles and the rigour of the methods used were low. Where methods of differentiation were described, they appear to be based on patient or family report rather than multidisciplinary assessment. CONCLUSION The heterogeneity in terms, lack of definitions, and limited investigation of injury intent means this variable is likely to be prone to misclassification bias. We strongly recommend that the global burn community unites to develop a common data element, including definitions and methods of assessment, for the concept of burn injury intent to enable more reliable data collection practices and interstudy comparisons.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, LL13 7YP, UK.
| | - Parvathy Ramesh
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rebecca McPhillips
- Social Care and Society, School of Health Sciences, Faculty of Biology Medicine and Health, Jean McFarlane Building, University of Manchester, M13 9PY, UK
| | - Fatima Bibi
- Turning Point, 5 Greaves Street, Oldham OL1 1QN, UK
| | - Murad Khan
- Department of Psychiatry and Brain and Mind Institute, Aga Khan University, Karachi 74800, Pakistan
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Mysore Medical College and Research Institute, KR hospital, Irwin Road, Mysuru, Karnataka 570001, India
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, LL13 7YP, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, Faculty of Biology Medicine and Health, Jean McFarlane Building, University of Manchester, M13 9PY, UK
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Poole R, Huxley P. Social prescribing: an inadequate response to the degradation of social care in mental health. BJPsych Bull 2024; 48:30-33. [PMID: 37526058 PMCID: PMC10801358 DOI: 10.1192/bjb.2023.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 08/02/2023] Open
Abstract
Social prescribing is poorly defined and there is little evidence for its effectiveness. It cannot address the social determinants of mental health and it is unlikely to produce enduring change for that part of the population that suffers the worst physical and mental health, namely the most deprived and marginalised. It has emerged at a time of growing health inequity. This has occurred alongside the neglect of social care and of the social aspects of mental health intervention. Social prescribing gives a false impression of addressing social factors, and as such is counterproductive. We can do better than this.
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Bebbington E, Ramesh P, Kakola M, McPhillips R, Bibi F, Hanif A, Morris N, Khan M, Poole R, Robinson C. Terminology and methods used to differentiate injury intent of hospital burn patients in South Asia: a systematic scoping review protocol. Syst Rev 2023; 12:153. [PMID: 37653528 PMCID: PMC10468849 DOI: 10.1186/s13643-023-02317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The greatest proportion of burn injuries globally occur in South Asia, where there are also high numbers of intentional burns. Burn injury prevention efforts are hampered by poor surveillance data on injury intent. There is a plethora of local routinely collected data in the research literature from South Asia that could be used for epidemiological purposes, but it is not known whether the definitions and methods of differentiation of injury intent are sufficiently homogenous to allow valid study comparisons. METHODS We will conduct a systematic scoping review to understand terminology and methods used to differentiate injury intent of hospital burn patients in South Asia. The objectives of the study are to: determine the breadth of terminology and common terms used for burn injury intent; to determine if definitions are comparable across studies where the same term is used; and to appraise the rigour of methods used to differentiate burn injury intent and suitability for comparison across studies. The databases Embase, MEDLINE, CINAHL, PsycINFO, and PakMediNet will be searched. Screening and data extraction will be completed independently by two reviewers. To be included, the article must be as follows: peer reviewed, primary research, study cutaneous burns, based on hospital patients from a country in South Asia, and use intent terminology or discuss a method of differentiation of injury intent. Results will be restricted to English language studies. No date restrictions will be applied. A plain language summary and terminology section are included for non-specialist readers. DISCUSSION Results will be used to inform stakeholder work to develop standardised terminology and methods for burn injury intent in South Asia. They will be published open access in peer-reviewed journals wherever possible. SYSTEMATIC REVIEW REGISTRATION This review has been registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/DCYNQ ).
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Bangor, LL13 7YP, UK.
| | - Parvathy Ramesh
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Mysore Medical College and Research Institute, Mysuru, India
| | - Rebecca McPhillips
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
| | | | | | - Nia Morris
- John Spalding Library, Wrexham Maelor Hospital, Wrexham, UK
| | - Murad Khan
- Brain and Mind Institute, Aga Khan University, Karachi, Pakistan
| | - Rob Poole
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Bangor, LL13 7YP, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester, UK
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Poole R, Cook CCH, Song R, Robinson CA. Psychiatrists' attitudes to professional boundaries concerning spirituality and religion: mixed-methods study. BJPsych Bull 2023:1-5. [PMID: 37589193 DOI: 10.1192/bjb.2023.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
AIMS AND METHOD Calls for the integration of spirituality into psychiatric practice have raised concerns about boundary violations. We sought to develop a method to capture psychiatrists' attitudes to professional boundaries and spirituality, explore consensus and understand what factors are considered. Case vignettes were developed, tested and refined. Three vignettes were presented to 80 mental health professionals (53% said they were psychiatrists; 39% did not identify their professional status). Participants recorded their reactions to the vignettes. Four researchers categorised these as identifying boundary violations or not and analysed the factors considered. RESULTS In 90% of cases, at least three of the four researchers agreed on classification (boundary violation; possible boundary violation; no boundary violation). Participants' opinion about boundary violations was heterogeneous. There was consensus that psychiatrists should not proselytise in clinical settings. Reasoning emphasised pragmatic concerns. Few participants mentioned their religious beliefs. Equivocation was common. CLINICAL IMPLICATIONS Mental health professionals seem unsure about professional boundaries concerning religion and spirituality in psychiatric practice.
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Huxley P, Krayer A, Poole R, Gromadzka A, Jie DL, Nafees S. The Goldberg-Huxley model of the pathway to psychiatric care: 21st-century systematic review. BJPsych Open 2023; 9:e114. [PMID: 37350326 DOI: 10.1192/bjo.2023.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The classification of mental disorders used to be based only on people seen by hospital psychiatrists. In fact, most people with a mental disorder were, and are, not seen by psychiatrists because of decisions made prior to psychiatric consultation. The first description of this 'pathway' to care and its levels and filters was published by Goldberg and Huxley in 1980. AIMS To conduct a review of papers relevant to the application of the Goldberg-Huxley model in the 21st century. METHOD Systematic review (PROSPERO registration CRD42021270603) of the pathway to psychiatric care in the 21st century. The review concentrates on community surveys and passage through the first filter (consultation in primary care or its equivalent). Ten databases were searched for papers meeting the defined inclusion criteria published between 2000 and 2019 and completed on 15 February 2020. RESULTS In total, 1824 papers were retrieved, 137 screened fully and 31 included in this review. The results are presented in a table comparing them with previous research. Despite major social, economic and health service changes since 1980, community prevalence and consultation rates remain remarkably consistent and in line with World Health Organization findings. Passage through the first filter is largely unchanged and there is evidence that the same factors operate internationally, especially gender and social parameters. CONCLUSIONS The Goldberg-Huxley model remains applicable internationally, but this may change owing to an increasingly mixed mental health economy and reduced access to primary care services.
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Affiliation(s)
- Peter Huxley
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Anne Krayer
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Rob Poole
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | | | | | - Sadia Nafees
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Bebbington E, Poole R, Kumar SP, Krayer A, Krishna M, Taylor P, Hawton K, Raman R, Kakola M, Srinivasarangan M, Robinson C. Establishing Self-Harm Registers: The Role of Process Mapping to Improve Quality of Surveillance Data Globally. Int J Environ Res Public Health 2023; 20:2647. [PMID: 36768009 PMCID: PMC9915364 DOI: 10.3390/ijerph20032647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Self-harm registers (SHRs) are an essential means of monitoring rates of self-harm and evaluating preventative interventions, but few SHRs exist in countries with the highest burden of suicides and self-harm. Current international guidance on establishing SHRs recommends data collection from emergency departments, but this does not adequately consider differences in the provision of emergency care globally. We aim to demonstrate that process mapping can be used prior to the implementation of an SHR to understand differing hospital systems. This information can be used to determine the method by which patients meeting the SHR inclusion criteria can be most reliably identified, and how to mitigate hospital processes that may introduce selection bias into these data. We illustrate this by sharing in detail the experiences from a government hospital and non-profit hospital in south India. We followed a five-phase process mapping approach developed for healthcare settings during 2019-2020. Emergency care provided in the government hospital was accessed through casualty department triage. The non-profit hospital had an emergency department. Both hospitals had open access outpatient departments. SHR inclusion criteria overlapped with conditions requiring Indian medicolegal registration. Medicolegal registers are the most likely single point to record patients meeting the SHR inclusion criteria from multiple emergency care areas in India (e.g., emergency department/casualty, outpatients, other hospital areas), but should be cross-checked against registers of presentations to the emergency department/casualty to capture less-sick patients and misclassified cases. Process mapping is an easily reproducible method that can be used prior to the implementation of an SHR to understand differing hospital systems. This information is pivotal to choosing which hospital record systems should be used for identifying patients and to proactively reduce bias in SHR data. The method is equally applicable in low-, middle- and high-income countries.
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Affiliation(s)
- Emily Bebbington
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
- Department of Emergency Medicine, Ysbyty Gwynedd, Bangor LL57 2PW, UK
| | - Rob Poole
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
| | - Sudeep Pradeep Kumar
- South Asia Self-Harm Initiative, JSS Hospital, Mysuru 570 004, India
- Department of Clinical Psychology, JSS Hospital, Mysuru 570 004, India
| | - Anne Krayer
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
| | - Murali Krishna
- Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham LL13 7YP, UK
- South Asia Self-Harm Initiative, JSS Hospital, Mysuru 570 004, India
| | - Peter Taylor
- Division of Psychology and Mental Health, University of Manchester, Manchester M13 9PL, UK
| | - Keith Hawton
- Centre for Suicide Research, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Rajesh Raman
- Department of Psychiatry, JSS Hospital, Mysuru 570 004, India
| | - Mohan Kakola
- Department of Plastic Surgery and Burns, Krishna Rajendra Hospital, Mysuru 570 001, India
| | | | - Catherine Robinson
- Social Care and Society, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
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Abstract
In this journal Ikkos examines the work of the American sociologist Owen Whooley, who argues that US psychiatry has gone through five paradigm shifts without defining the object of its own expertise. We look at the substance of Whooley's methods and assumptions and offer our observations on Ikkos's argument and conclusions.
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Lepping P, Poole R. Psychiatry's need for Vergangenheitsbewältigung: 'culture wars', cognitive dissonance and coming to terms with the past. BJPsych Open 2022; 8:e202. [PMID: 36412189 PMCID: PMC9707497 DOI: 10.1192/bjo.2022.607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UK psychiatry's sense of self rests on being part of a socially progressive national tradition. This makes it difficult to engage with more critical narratives. The process of analysing and accepting psychiatry's past can help our profession to get closer to its real self and on a path to a better future.
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Affiliation(s)
- Peter Lepping
- Betsi Cadwaladr University Health Board, Wrexham, Wales; Centre for Mental Health and Society, Bangor University, Wales; and Mysore Medical College and Research Institute, Mysuru, India
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Lewis C, Lewis K, Roberts A, Evison C, Edwards B, John A, Lloyd K, Pearce H, Poole R, Richards N, Robinson C, Jones I, Bisson JI. COVID-19-related posttraumatic stress disorder in adults with lived experience of psychiatric disorder. Depress Anxiety 2022; 39:564-572. [PMID: 35536094 PMCID: PMC9348441 DOI: 10.1002/da.23262] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/09/2022] [Accepted: 04/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Prevalence estimates of COVID-19-related posttraumatic stress disorder (PTSD) have ranged from 1% to over 60% in the general population. Individuals with lived experience of a psychiatric disorder may be particularly vulnerable to COVID-19-related PTSD but this has received inadequate attention. METHODS Participants were 1571 adults with lived experience of psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic. PTSD was assessed by the International Trauma Questionnaire (ITQ) anchored to the participant's most troubling COVID-19-related experiencevent. Factors hypothesised to be associated with traumatic stress symptoms were investigated by linear regression. RESULTS 40.10% of participants perceived some aspect of the pandemic as traumatic. 5.28% reported an ICD-11 PTSD qualifying COVID-19 related traumatic exposure and 0.83% met criteria for probable ICD-11 COVID-19-related PTSD. Traumatic stress symptoms were associated with younger age, lower income, lower social support, and financial worries, and lived experience of PTSD/complex PTSD. Depression and anxiety measured in June 2020 predicted traumatic stress symptoms at follow-up approximately 20 weeks later in November 2020. CONCLUSIONS We did not find evidence of widespread COVID-19-related PTSD among individuals with lived experience of a psychiatric disorder. There is a need for future research to derive valid prevalence estimates of COVID-19-related PTSD.
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Affiliation(s)
- Catrin Lewis
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Katie Lewis
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Alice Roberts
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Claudia Evison
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Bethan Edwards
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Ann John
- National Centre for Mental Health, Population Data ScienceSwansea University Medical SchoolSwanseaUK
| | - Keith Lloyd
- National Centre for Mental Health, Population Data ScienceSwansea University Medical SchoolSwanseaUK
| | - Holly Pearce
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Rob Poole
- National Centre for Mental Health, Centre for Mental Health and SocietyBangor UniversityBangorUK
| | - Natalie Richards
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Catherine Robinson
- Social Care and Society, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Ian Jones
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
| | - Jonathan I. Bisson
- Division of Psychological Medicine and Clinical Neurosciences, National Centre for Mental HealthCardiff University School of MedicineCardiffUK
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Poole R, Richardson B. Rebuttal From Drs Poole and Richardson. Chest 2022; 161:887. [PMID: 35396050 DOI: 10.1016/j.chest.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rob Poole
- Centre for Mental Health and Society, School of Medicine and Health Sciences, Bangor University, Bangor, Wales.
| | - Ben Richardson
- Knoll Surgery, Princeway Health Centre, Frodsham, England
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Poole R, Robinson CA. Breaking out of the citadel: social theory and psychiatry. BJPsych Bull 2022; 47:146-149. [PMID: 35289262 DOI: 10.1192/bjb.2022.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
British psychiatry has tended to hold itself aloof from social theory. Nonetheless, these ideas have influenced the development of mental health services. Alongside this, the biopsychosocial model cannot reconcile contradictions in the scientific evidence regarding mental illness. We need to develop a more constructive understanding of the implications of social theory.
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Lewis KJS, Lewis C, Roberts A, Richards NA, Evison C, Pearce HA, Lloyd K, Meudell A, Edwards BM, Robinson CA, Poole R, John A, Bisson JI, Jones I. The effect of the COVID-19 pandemic on mental health in individuals with pre-existing mental illness. BJPsych Open 2022; 8:e59. [PMID: 35249586 PMCID: PMC8914135 DOI: 10.1192/bjo.2022.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is evidence that the COVID-19 pandemic has negatively affected mental health, but most studies have been conducted in the general population. AIMS To identify factors associated with mental health during the COVID-19 pandemic in individuals with pre-existing mental illness. METHOD Participants (N = 2869, 78% women, ages 18-94 years) from a UK cohort (the National Centre for Mental Health) with a history of mental illness completed a cross-sectional online survey in June to August 2020. Mental health assessments were the GAD-7 (anxiety), PHQ-9 (depression) and WHO-5 (well-being) questionnaires, and a self-report question on whether their mental health had changed during the pandemic. Regressions examined associations between mental health outcomes and hypothesised risk factors. Secondary analyses examined associations between specific mental health diagnoses and mental health. RESULTS A total of 60% of participants reported that mental health had worsened during the pandemic. Younger age, difficulty accessing mental health services, low income, income affected by COVID-19, worry about COVID-19, reduced sleep and increased alcohol/drug use were associated with increased depression and anxiety symptoms and reduced well-being. Feeling socially supported by friends/family/services was associated with better mental health and well-being. Participants with a history of anxiety, depression, post-traumatic stress disorder or eating disorder were more likely to report that mental health had worsened during the pandemic than individuals without a history of these diagnoses. CONCLUSIONS We identified factors associated with worse mental health during the COVID-19 pandemic in individuals with pre-existing mental illness, in addition to specific groups potentially at elevated risk of poor mental health during the pandemic.
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Affiliation(s)
- Katie J S Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Catrin Lewis
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Alice Roberts
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Natalie A Richards
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Claudia Evison
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Holly A Pearce
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Keith Lloyd
- Swansea Medical School, Swansea University, UK
| | - Alan Meudell
- Partnership in Research, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Bethan M Edwards
- Partnership in Research, National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Catherine A Robinson
- Social Care and Society Research Group, School of Health Sciences, University of Manchester, UK
| | - Rob Poole
- Centre for Mental Health and Society, Bangor University, UK
| | - Ann John
- Population Data Science Group, Swansea University Medical School, Swansea University, UK
| | - Jonathan I Bisson
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
| | - Ian Jones
- National Centre for Mental Health, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, UK
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O'Sullivan RJ, Aykanat T, Johnston S, Rogan G, Poole R, Prodöhl PA, de Eyto E, Primmer CR, McGinnity P, Reed TE. Correction to: 'Captive-bred Atlantic salmon released into the wild have fewer offspring than wild-bred fish and decrease population productivity'. Proc Biol Sci 2021; 288:20211244. [PMID: 34187200 DOI: 10.1098/rspb.2021.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Huxley P, Krayer A, Poole R, Prendergast L, Aryal S, Warner R. Schizophrenia outcomes in the 21st century: A systematic review. Brain Behav 2021; 11:e02172. [PMID: 33991072 PMCID: PMC8213926 DOI: 10.1002/brb3.2172] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/16/2021] [Accepted: 04/23/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE We report a review of outcomes in schizophrenia in the twenty-first century, replicating and extending work undertaken by the late Richard Warner in his seminal book, "Recovery from Schizophrenia: Psychiatry and Political Economy" (1985;2004). METHOD Warner's methods were followed as closely as possible. Only observational/naturalistic studies were included. Six scientific databases were searched from 2000 to 2020. 6,640 records were retrieved. 47 met inclusion criteria. RESULTS Overall, complete recovery is higher in this study than in Warner's (37.75% cf 20.4%), especially for first episode psychosis (FEP) (57.1% cf 20.7%). Clinical recovery, annualized remission rate (ARR), and employment outcomes were significantly superior for first episode psychosis compared with multiple episode psychosis (MEP). ARR shows a trend toward reduction over time, from 2.2 before the financial crash of 2008 to 1.6 after (t = 1.85 df 40 p = .07). The decline is statistically significant for the MEP group (t = 2.32 df18 p = .03). There were no differences in outcome by region, sample characteristics, outcome measures used, or quality of studies. Heterogeneity of clinical outcome measures across the literature makes evidence synthesis difficult. Weak and inconsistent reporting of functional and employment outcomes mean that findings lack meaning with respect to lived experience. CONCLUSION Future research strategies should aim to reduce heterogeneity in clinical outcome measures and to increase the emphasis on capture and reporting of more sophisticated measures of social and functional outcome. Outcome domains should be disaggregated rather than conflated into unitary recovery constructs.
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Affiliation(s)
- Peter Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Anne Krayer
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Louise Prendergast
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Sanjaya Aryal
- Department of Sociology, University of Essex, Colchester, UK
| | - Richard Warner
- Clinical Professor of Psychiatry and Adjunct Professor of Anthropology, University of Colorado, Denver, CO, USA
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Bebbington E, Lawson J, Nafees S, Robinson C, Poole R. Evaluation of a framework for safe and appropriate prescribing of psychoactive medications in a UK prison. Crim Behav Ment Health 2021; 31:131-142. [PMID: 33306258 DOI: 10.1002/cbm.2187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The widespread use of drugs in prisons leads to avoidable deaths, poorer health and a poor living environment. The contribution of psychoactive prescription drugs to this problem has received little attention in prison policy or at individual prescriber level. AIMS To determine the extent of unsafe and inappropriate prescribing of psychoactive medications in one UK prison using a newly developed medicines optimisation framework. METHOD A medicines optimisation framework was developed based on principles of good prescribing. It was initiated on the opening of a new prison-HMP Berwyn-in February 2017. During the study period, all prisoners at HMP Berwyn were transferred from other prisons. The safety and appropriateness of psychoactive medications were evaluated de novo on reception at HMP Berwyn and during follow up, using the medicines optimisation framework. RESULTS About 1941 sentenced men arrived at HMP Berwyn between February 2017 and November 2018. Nearly one-third (634, 33%) were on a prescribed psychoactive medication. Seventy-five percent of these (474/634) required a prescription change due to appropriateness or safety concerns. Nearly half (295, 46.5%) received changes at reception despite having already undergone medicines reconciliation at their previous prison. Forty-three percent (275/634) received changes at follow up, most commonly those who had no prior risks identified at reception. CONCLUSIONS Inappropriate and unsafe prescribing of psychoactive medications is occurring in prisons despite mandatory medication reviews. Ongoing monitoring is required to reduce the risk from these medications. A medicines optimisation framework such as this could be adopted across other prisons, worldwide, to help contribute to risk reduction from drug use in prisons. Appropriately modified, a similar framework might help reduce inappropriate and harmful prescribing in hospitals and in the community.
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Affiliation(s)
- Emily Bebbington
- Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
- Department of Emergency Medicine, Ysbyty Gwynedd, Bangor, Wales, UK
| | | | - Sadia Nafees
- Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
| | - Catherine Robinson
- Social Care and Society, School of Health Sciences, Manchester University, Manchester, UK
| | - Rob Poole
- Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
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Bailey J, Nafees S, Jones L, Poole R. Rationalisation of long-term high-dose opioids for chronic pain: development of an intervention and conceptual framework. Br J Pain 2020; 15:326-334. [PMID: 34381614 DOI: 10.1177/2049463720958731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There has been a large increase in the number of prescriptions for opioid drugs in the United Kingdom over the last 20 years or more and the prescribing of opioids in high doses continues to increase. Much opioid prescribing is for chronic non-cancer pain (CNCP) despite serious doubts about the long-term effectiveness of opioids for this indication. Clinical experience is that there are increasing numbers of patients who are on high dosages of opioid drugs over sustained periods which provide limited or no pain relief while having significant negative effects on functioning and quality of life. The aim of this article is to bring readers' attention to some clinical observations of the CNCP population with high doses and to describe an intervention to reduce these doses. Many of these patients have no clinical features of addiction; we suggest that those who show little or no substance misuse behaviours are best understood as a distinct clinical population who have different treatment needs. In order to understand and treat these patients, a model is required which, rather than seeing the problem as lying solely with the patient, focuses on the interaction between the individual and his or her environment and seeks a change in what the patient does every day, rather than a simple, and largely unattainable, goal of symptom elimination. The clinician authors worked together to develop an intervention based upon approaches taken from both pain management and psychiatric practice. A detailed description of this rapid opioid reduction intervention (RORI) is provided along with some preliminary outcome data.
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Affiliation(s)
- John Bailey
- Centre for Mental Health and Society, Bangor University, Wrexham, UK
| | - Sadia Nafees
- Centre for Mental Health and Society, Bangor University, Wrexham, UK
| | - Lucy Jones
- Betsi Cadwaladr University Health Board, Wrexham, UK
| | - Rob Poole
- Centre for Mental Health and Society, Bangor University, Wrexham, UK.,Betsi Cadwaladr University Health Board, Wrexham, UK
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Harding K, Poole R, Robinson C. The outsourcing of risk: out-of-area placements for individuals diagnosed with personality disorder in the UK. Lancet Psychiatry 2020; 7:730-731. [PMID: 32828154 DOI: 10.1016/s2215-0366(20)30148-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 02/17/2020] [Accepted: 03/31/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Rob Poole
- Centre for Mental Health and Society, School of Health Sciences, Prifysgol Bangor University, Bangor, UK
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Poole R. The sacred versus the secular in UK psychiatry. BJPsych advances 2020. [DOI: 10.1192/bja.2020.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYI comment on two papers by Koenig and colleagues that advocate the integration of religion into routine psychiatric practice. In my opinion, their selective overview of research, although useful, lacks balance. It omits any mention of the literature on worldwide scandals over child sex abuse (and other abuses of power) perpetrated and facilitated by religious authority within several faith groups. There is no mention of damaging ‘religiously informed’ treatments such as sexual orientation conversion therapy, which is still practised in the UK despite widespread condemnation. Their recommendations for clinical practice conflate association with causation. They do not offer practice guidance on managing the impact of power imbalances associated with religion in multicultural societies. In summary, despite more than a decade of research and debate, there are still no generally accepted ways of avoiding boundary violations where psychiatrists introduce religion into their clinical practice.
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20
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Campbell S, Poole R. Editorial: Disorderly street users of novel psychoactive substances: What might help? Crim Behav Ment Health 2020; 30:53-58. [PMID: 32363641 DOI: 10.1002/cbm.2146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Stephen Campbell
- Head of Service - North Wales, Hafal, Wrexham Homelessness Prevention Project, Wrexham, UK
| | - Rob Poole
- Centre for Mental Health and Society, Bangor University, Bangor, UK
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Lepping P, Whittington R, Sambhi R, Lane S, Poole R, Leucht S, Cuijpers P, McCabe R, Waheed W. Clinical relevance of findings in trials of CBT for depression. Eur Psychiatry 2020; 45:207-211. [DOI: 10.1016/j.eurpsy.2017.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 07/08/2017] [Indexed: 12/15/2022] Open
Abstract
AbstractCognitive behavioural therapy (CBT) is beneficial in depression. Symptom scores can be translated into Clinical Global Impression (CGI) scale scores to indicate clinical relevance. We aimed to assess the clinical relevance of findings of randomised controlled trials (RCTs) of CBT in depression. We identified RCTs of CBT that used the Hamilton Rating Scale for Depression (HAMD). HAMD scores were translated into Clinical Global Impression – Change scale (CGI-I) scores to measure clinical relevance. One hundred and seventy datasets from 82 studies were included. The mean percentage HAMD change for treatment arms was 53.66%, and 29.81% for control arms, a statistically significant difference. Combined active therapies showed the biggest improvement on CGI-I score, followed by CBT alone. All active treatments had better than expected HAMD percentage reduction and CGI-I scores. CBT has a clinically relevant effect in depression, with a notional CGI-I score of 2.2, indicating a significant clinical response. The non-specific or placebo effect of being in a psychotherapy trial was a 29% reduction of HAMD.
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22
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Poole R, Bailey J, Robinson CA. The opioid crisis and British prisons. Crim Behav Ment Health 2020; 30:1-5. [PMID: 31837040 DOI: 10.1002/cbm.2136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Rob Poole
- Centre for Mental Health and Society, Bangor University, Wrexham Technology Park, Wrexham, Wales
| | - John Bailey
- Centre for Mental Health and Society, Bangor University, Bangor, Wales
| | - Catherine A Robinson
- Social Care and Society, School of Health Sciences, Manchester University, Manchester, England
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Lee JDE, Bowley DM, Miles JA, Muzaffar J, Poole R, Orr LE. The Downrange Acoustic Toolbox: An Active Solution for Combat-Related Acute Acoustic Trauma. J Spec Oper Med 2020; 20:104-111. [PMID: 33320322 DOI: 10.55460/r1ky-m91z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 06/12/2023]
Abstract
Frontline military personnel are at high risk of acute acoustic trauma (AAT) caused by impulse noise, such as weapon firing or blast. This can result in anatomic disruption of the tympanic membrane and damage to the middle and inner ear, leading to conductive, sensorineural, or mixed hearing loss that may be temporary or permanent. AAT reduces warfighters' operational effectiveness and has implications for future quality of life. Hearing protection devices can mitigate AAT but are not completely protective. Novel therapeutic options now exist; therefore, identification of AAT as soon as possible from point of injury is vital to ensure optimal treatment and fulfillment of the duty of care. Early recognition and treatment of frontline AAT can maintain the deployed team's capabilities, avoid unnecessary case evacuation (CASEVAC), and raise awareness of military occupational AAT. This will help prioritize hearing preservation, maintain the fighting force, and ultimately retain personnel in service. The UK Defence hearWELL research collaboration has developed a frontline protocol for the assessment of AAT utilizing future-facing technology developed by the US Department of Defense: the Downrange Acoustic Toolbox (DAT). The DAT has been operationally deployed since 2019 and has successfully identified AAT requiring treatment, thereby improving casualties' hearing and reducing unnecessary repatriation.
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Abstract
The consensus within psychiatry is that patients' religion/spirituality are legitimate topics in assessment and treatment. Religion/spirituality can help people cope with mental illness, but their use as therapeutic tools is controversial. Despite the publication of position statements by national and international psychiatric organisations, there is no clarity over therapeutic boundaries.Declaration of interestR.P. and R.H. are atheists. C.C.H.C. is an ordained Anglican and a past Chair of the Royal College of Psychiatrists Spirituality and Psychiatry Special Interest Group. He writes here in a personal capacity.
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Affiliation(s)
- Rob Poole
- Professor of Social Psychiatry,School of Health Sciences, Bangor University and Co-Director,Centre for Mental Health and Society,Bangor University,UK
| | - Christopher C H Cook
- Professor of Spirituality, Theology & Health, Theology and Religion,Durham University and Honorary Minor Canon,Durham Cathedral,UK
| | - Robert Higgo
- Senior Lecturer in Social Psychiatry, Centre for Mental Health and Society,Bangor University,UK
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Masood B, Lepping P, Romanov D, Poole R. Treatment of Alcohol-Induced Psychotic Disorder (Alcoholic Hallucinosis)-A Systematic Review. Alcohol Alcohol 2018; 53:259-267. [PMID: 29145545 DOI: 10.1093/alcalc/agx090] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/23/2017] [Indexed: 11/13/2022] Open
Abstract
Aims To evaluate the effectiveness of evidence based treatments for alcohol-induced psychotic disorder (AIPD) as described by ICD-10 and DSM-5, a condition that is distinct from schizophrenia and has a close relationship with alcohol withdrawal states. Method Systematic review using PRISMA guidelines. Results Of 6205 abstracts found, fifteen studies and ten case reports met criteria and were examined. Larger studies examined the use of first-generation antipsychotic drugs, reporting full or partial remission in most patients. Newer case reports report similar results using second generation antipsychotic drugs. Novel treatments, such as those acting on GABA receptors reported low numbers of patients in remission. Some large studies report the successful use of standard alcohol withdrawal treatments. Conclusion The findings of our systematic review are inconclusive. There was significant heterogeneity between and within studies. Significant publication bias is likely. Randomized control trials of more carefully delineated samples would produce evidence of greater clinical utility, for example, on differential effectiveness of antipsychotics and optimal length of standard alcohol withdrawal treatments. AIPD patients who show poor treatment responses should be studied in greater depth. Short Summary This systematic review of alcohol-induced psychotic disorder treatment found 15 studies and 10 case reports of relevance. Older studies of first-generation antipsychotics reported full or partial remission in most patients, as did newer studies with second-generation antipsychotics. Novel drugs reported low remission rates. Standard alcohol withdrawal treatments were successful.
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Affiliation(s)
- Barkat Masood
- Betsi Cadwaladr University Health Board (BCUHB), Heddfan Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, UK
| | - Peter Lepping
- Betsi Cadwaladr University Health Board (BCUHB), Heddfan Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, UK.,Centre for Mental Health and Society (University of Bangor), Wrexham Medical Institute, Technology Park Centre, Croesnewydd Road, Wrexham, Wales LL13 7YP, UK.,Mysore Medical College & Research Institute, Irwin Road, Next to Railway Station, Mysuru, Karnataka 570001, India
| | - Dmitry Romanov
- Department of Psychiatry & Psychosomatics, I.M. Sechenov First Moscow State Medical University, Malaya Trubetskaya Ulitsa, 8c2, Moskva 119992, Russia.,Mental Health Research Center, 34, Kashirskoye shosse, Moskva 115522, Russia
| | - Rob Poole
- Betsi Cadwaladr University Health Board (BCUHB), Heddfan Unit, Wrexham Maelor Hospital, Wrexham, Wales LL13 7TD, UK.,Centre for Mental Health and Society (University of Bangor), Wrexham Medical Institute, Technology Park Centre, Croesnewydd Road, Wrexham, Wales LL13 7YP, UK
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Krayer A, Robinson CA, Poole R. Exploration of joint working practices on anti-social behaviour between criminal justice, mental health and social care agencies: A qualitative study. Health Soc Care Community 2018; 26:e431-e441. [PMID: 29349844 DOI: 10.1111/hsc.12543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2017] [Indexed: 06/07/2023]
Abstract
Although the police play an important role for people with mental health problems in the community, little is known about joint working practices between mental health, social care and police services. There is potential for tensions and negative outcomes for people with mental health problems, in particular when the focus is on behaviours that could be interpreted as anti-social. This study explores perceptions about joint working between mental health, social care and police services with regard to anti-social behaviour. We conducted a multi-method sequential qualitative study in the UK collecting data between April 2014 and August 2016. Data were collected from two study sites: 60 narrative police logs of routinely gathered information, and semi-structured interviews and focus groups with professionals from a range of statutory and third sector organisations (N = 55). Data sets were analysed individually, using thematic iterative coding before integrating the findings. We also looked at sequencing and turning points in the police logs. Findings mapped on a continuum of joint working practices, with examples more likely to be away from the policy ideal of partnership working as being central to mainstream activities. Joint working was driven by legal obligations and concerns about risk rather than a focus on the needs of a person with mental health problems. This was complicated by different perceptions of the police role in mental health. Adding anti-social behaviour to this mix intensified challenges as conceptualisation of the nature of the problem and agreeing on best practice and care is open to interpretations and judgements. Of concern is an evident lack of awareness of these issues. There is a need to reflect on joint working practices, including processes and goals, keeping in mind the health and welfare needs of people with mental health problems.
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Affiliation(s)
- Anne Krayer
- School of Social Sciences, Bangor University, Bangor, UK
| | | | - Rob Poole
- School of Social Sciences, Bangor University, Bangor, UK
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Abstract
‘Drug induced psychosis' is a commonly used clinical label but lacks a universally accepted definition. Psychiatrists' understanding of the term was examined using a specifically designed questionnaire. Knowledge about the effects of drugs of abuse and their relationship with psychosis was also examined. A substantial proportion of clinicians did not have a logical and coherent scheme for understanding ‘drug-induced psychosis' and there was no consensus as to which reactions to drug taking should be included within the rubric. Diagnostic errors have potentially serious consequences, so lack of knowledge in this area needs attention and a proposed classification is given.
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Abstract
Aims and methodTo determine the pattern of psychotropic prescribing in a group of people with psychosis who were living in the community under community mental health team (CMHT) care. Case-note entries over the previous 12 months were examined.ResultsOnly a third of individuals were on one psychotropic medication. Atypical antipsychotics were prescribed to 80.6%. Polypharmacy was common. A third of people were taking three or more psychotropic drugs and 13.7% were on high-dose regimes, mostly involving two atypical antipsychotics.Clinical implicationsThe use of atypicals has not eliminated polypharmacy or high-dose antipsychotic regimes. Clinicians need to be aware of this long-standing problem.
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Abstract
Aims and methodTo assess the stability of the diagnosis of first-episode drug-induced psychosis over a follow-up period of at least 2 years. Patients with no psychiatric history who had been discharged from in-patient care between January 2002 and April 2006 with a firm diagnosis of drug-induced psychosis were identified. Follow-up information for at least the next 2 years or until discharge from mental health services was collected retrospectively from psychiatric records.ResultsNearly all of the patients who remained under psychiatric follow-up had a change in diagnosis, most commonly to a schizophreniform disorder. Those who were retained in follow-up had significantly longer index admissions than those discharged to primary care (P = 0.05).Clinical implicationsThis study suggests that many individuals diagnosed with drug-induced psychosis are further diagnosed as having a functional psychosis, usually schizophreniform in nature. This is compatible with the suggestion that individuals diagnosed with drug-induced psychosis are experiencing either the effects of drug intoxication or an ordinary functional psychosis complicated by incidental drug use.
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Poole R, Higgo R, Strong G, Kennedy G, Ruben S, Barnes R, Lepping P, Mitchell P. Religion, psychiatry and professional boundaries. Psychiatr bull 2018. [DOI: 10.1192/pb.32.9.356] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Poole R, Robinson CA. Profile: Vanessa Cameron - 36 years at the Royal College of Psychiatrists. BJPsych Bull 2016; 40:341-345. [PMID: 28377815 PMCID: PMC5353516 DOI: 10.1192/pb.bp.116.055459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
On 16 December 2016, Vanessa Cameron retires as Chief Executive of the Royal College of Psychiatrists. She started working there in September 1980 and in 1984 she became Secretary of the College, the role that preceded chief executive. The College was formed in 1971, so Vanessa has been present for most of its lifetime. It has been a period of continuous change that has seen psychiatry leave the old mental hospitals, expand considerably in the late 1990s and early part of the 21st century, and come under huge pressure more recently. Although she has never worked within mental health services, Vanessa has been at the heart of British psychiatry for 36 years. She was awarded an MBE in the 2013 New Year's Honours list for services to psychiatry. We interviewed Vanessa at 21 Prescot Street on 3 August 2016.
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Poole R, McCracken V, Rhoads M, Lee K. 213 MATURATION OF OOCYTES WITH FOLLICULAR FLUID FROM GILTS CONSUMING HIGH FAT AND FRUCTOSE AFFECTS SUBSEQUENT EMBRYO DEVELOPMENT. Reprod Fertil Dev 2016. [DOI: 10.1071/rdv28n2ab213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infertility among women has become a growing issue in the world requiring a significant number to seek treatment by means of assisted reproductive technologies. One suggested reason for the fertility issue, which is known to specifically affect oocyte quality, is the modern diet. Previously, we have demonstrated that feeding a high-fructose diet to gilts led to poor reproductive tract characteristics and infertility. In this study, pre-pubescent gilts were fed either a high-fructose; high-fat diet (HFHF), with 15% beef tallow and 35% fructose; or an industry control diet (IND). Porcine follicular fluid (pFF) collected from these gilts was introduced into in vitro maturation systems to determine whether characteristics of the follicular fluid affect oocyte competence and embryo development. Follicles from ovaries, collected at a local abattoir, were aspirated by an 18 G needle attached to a 10-mL sterile syringe. Then selected cumulus‐oocyte complexes were maturated in vitro in a TCM-199 maturation media with cysteine, glucose, sodium pyruvate, epidermal growth factor (EGF), FSH, LH, and 20% pFF from treatment groups. Additionally, another group of oocytes, labelled follicle fluid free (FFF), were maturated in TCM-199 media without pFF. Three replicate experiments were conducted using a total of 365 oocytes, 124 FFF, 121 IND, and 120 HFHF. Oocytes were denuded by exposure to 0.1% hyaluronidase and oocytes that reached metaphase II (MII) were selected for in vitro fertilisation. After 5 h of co-incubation in modified Tween medium B with milk powder (mTBM)-based IVF media, presumable zygotes were transferred to porcine zygote medium-3 (PZM-3). Blastocyst frequency was recorded on Days 5 and 6. Day 6 blastocysts were stained with Hoechst for total cell number evaluation. The frequencies of blastocyst formation among the treatment groups were compared by a chi-squared test, and total cell numbers were compared by Student's t-test. Statistical significance was defined by P < 0.05. The frequency of oocytes reaching metaphase II (MII) were observed as 77.4% FFF, 72.7% IND, and 71.7% HFHF (P > 0.05), indicating the supplementation of pFF did not affect maturation. Day 5 blastocysts were observed at frequencies of 8.3% FFF, 6.8% IND, and 4.7% HFHF and did not differ. However, frequency of Day 6 blastocysts from HFHF group was tended to be lower compared with that of other groups; 12.5% FFF, 11.4% IND, and 4.7% HFHF (P = 0.06 and P = 0.1). Average total cell number of Day 6 blastocysts observed were 41.0 ± 9.1 FFF, 36.0 ± 8.9 IND, and 48.3 ± 10.6 HFHF. The total cell number from HFHF group tended to be higher than only that of IND group (P = 0.07). Based on these results, we concluded that the follicular fluid of females consuming HFHF diets did not have impact on nuclear maturation of oocytes but might affect oocyte competency, thus resulting in detrimental effects on subsequent development of embryos, especially blastocyst formation. Further studies will help us identify more specific effects of nutrition on oogenesis and subsequent embryo development.
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McCrum C, McGowan J, Stenner P, Cross V, Defever E, Lloyd P, Poole R, Moore A. Self-management in chronic low back pain: understanding differing viewpoints held by patients and healthcare providers to improve communication. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Poole R. NHS morality and care based on compassionate values. BJPsych Bull 2015; 39:48-9. [PMID: 26191426 PMCID: PMC4495834 DOI: 10.1192/pb.39.1.48a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Krishna M, Rajendra R, Majgi SM, Heggere N, Parimoo S, Robinson C, Poole R. Severity of suicidal intent, method and behaviour antecedent to an act of self-harm: a cross sectional study of survivors of self-harm referred to a tertiary hospital in Mysore, south India. Asian J Psychiatr 2014; 12:134-9. [PMID: 25441305 DOI: 10.1016/j.ajp.2014.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/22/2014] [Accepted: 09/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Rates of self harm are high in south India, but little is known about the relationship between antecedent behaviour, suicidal intent and method. Aims: To identify clinical, social and behavioural antecedents preceding an act of self-harm. METHODS 200 participants, consecutively presenting with deliberate self harm to a hospital in south India,were interviewed. Socio-demographic and clinical characteristics were recorded, together with behaviours preceding self-harm. The Pierce Suicidal Intent Scale and Mini International Neuropsychiatric Inventory were administered. RESULTS Pesticide poisoning was the most common method, especially amongst men, in rural areas, and amongst professionals. No particular antecedent behaviour or activity appears to be associated with higher levels of suicidal intent. Absenteeism from work was the most commonly reported change of behaviour in the month preceding an act of self-harm. Unskilled labourers and professionals had significantly greater suicidal intent (adjusted for age, gender and method) than skilled labourers and the unemployed. There were no differences in suicidal intent between different methods. Rural dwellers had significantly greater suicidal intent compared to urban dwellers, irrespective of the method. Major Depressive Disorder was associated with significantly greater suicidal intent compared with other diagnoses and no diagnosis. CONCLUSIONS Amongst people who harm themselves in south India, professionals and unskilled labourers, rural residents, and people with current major depressive disorder have higher levels of suicidal intent. Severity of suicidal intent does not appear to influence choice of method of self-harm. Behaviours predictive of self-harm in the west may not be relevant in south India.
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Affiliation(s)
- Murali Krishna
- Early Career Research Fellow, Wellcome DBT Alliance and Consultant Psychiatrist at CSI Holdsworth Memorial Hospital, PO Box 28, Mandimohalla, Mysore 570021, India
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Lepping P, Schönfeldt-Lecuona C, Sambhi RS, Lanka SVN, Lane S, Whittington R, Leucht S, Poole R. A systematic review of the clinical relevance of repetitive transcranial magnetic stimulation. Acta Psychiatr Scand 2014; 130:326-41. [PMID: 24724996 DOI: 10.1111/acps.12276] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) is an approved treatment for depression. The clinical relevance of its efficacy is unclear. The clinical relevance of findings in the rTMS literature was assessed by translating Hamilton Depression Rating Scale (HAMD) data into Clinical Global Impression-Improvement scale (CGI-I) scores. METHOD We performed electronic searches of MEDLINE, Embase, PsycINFO, PubMed and Cochrane Central Register of Controlled Trials for RCTs and non-RCT trials on rTMS using Hamilton Depression Rating Scale (HAMD). Articles were included if published in English before January 2014. We translated HAMD scores into nominal CGI-I scores for rTMS for depression and for treatment-resistant depression (TRD). RESULTS About 960 abstracts were retrieved. Sixty-three studies were included, yielding 130 study arms. For depression, the mean percentage change in HAMD scores in all sham-controlled rTMS treatment arms was 35.63 (SD 16.35) and for sham-rTMS 23.33 (SD 16.51). For TRD, active rTMS in sham-controlled studies showed a mean HAMD percentage reduction of 45.21 (SD 10.94) versus 25.04 (SD 17.55) for sham-rTMS. When aggregated scores were translated into notional CGI-I scores, for the treatment of depression, the notional CGI-I score difference between rTMS and sham-rTMS was 0.5 in favour of rTMS; for TRD, it was 0.75 in favour of rTMS. Differences between rTMS and sham-rTMS were bigger when all study arms were combined. CONCLUSION Whilst rTMS appears to be efficacious for both non-refractory and treatment-resistant depression, the clinical relevance of its efficacy is doubtful.
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Affiliation(s)
- P Lepping
- Department of Psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK; Centre for Mental Health and Society, Bangor University, Wrexham, Wales, UK
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Poole R, Pearsall A, Ryan T. Delayed discharges in an urban in-patient mental health service in England. Psychiatr Bull (2014) 2014; 38:66-70. [PMID: 25237501 PMCID: PMC4115402 DOI: 10.1192/pb.bp.113.043083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/21/2013] [Accepted: 07/09/2013] [Indexed: 11/23/2022]
Abstract
Aims and method To describe the clinical and demographic characteristics of all in-patients experiencing delayed discharge over 3 months in an English urban mental health National Health Service trust. We carried out a cross-sectional case record study with care coordinator questionnaire. Results Overall, 67 in-patients with delayed discharge occupied 18.6% of acute beds. Older in-patients were White, diagnosed with dementia and experienced relatively short admissions. Younger in-patients were often of Black and minority ethnic background with a psychotic diagnosis and long service contact, and sometimes experienced very long admissions. They were similar to a long-stay comparison group. The whole cohort was socially isolated and marginalised, and frequently misused alcohol. Clinical implications People with complex mental health problems can experience long stays in acute care settings. This particularly affects people with psychosis who are isolated in the community. Alcohol misuse is the most common complicating factor. There are insufficient community-oriented rehabilitation services to meet these patients' diverse needs.
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Melià P, Crivelli AJ, Durif C, Poole R, Bevacqua D. A simplified method to estimate body growth parameters of the European eel Anguilla anguilla. J Fish Biol 2014; 85:978-984. [PMID: 25130672 DOI: 10.1111/jfb.12486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 06/27/2014] [Indexed: 06/03/2023]
Abstract
A simple approach is proposed to fit a body growth model for the European eel Anguilla anguilla to data-poor case studies. The model is a modified von Bertalanffy curve allowing for delayed sex determination and sexual dimorphism. The proposed procedure provides preliminary estimates of model parameters on the basis of average age and body length of silver eels.
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Affiliation(s)
- P Melià
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, via Ponzio 34/5, 20133 Milano, Italy
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Affiliation(s)
- Rob Poole
- Rob Poole, Professor of Social Psychiatry, Centre for Mental Health and Society, Bangor University.
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Becerra-Jurado G, Cruikshanks R, O'Leary C, Kelly F, Poole R, Gargan P. Distribution, prevalence and intensity of Anguillicola crassus (Nematoda) infection in Anguilla anguilla in the Republic of Ireland. J Fish Biol 2014; 84:1046-1062. [PMID: 24627948 DOI: 10.1111/jfb.12344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 01/14/2014] [Indexed: 06/03/2023]
Abstract
This study is the first comprehensive documentation of the geographical range of Anguillicola crassus in its host, the European eel Anguilla anguilla, in the Republic of Ireland. The prevalence and intensity of infections across 234 sites and 93 river basins in Ireland comprising rivers, lakes and transitional waters (estuaries) were analysed. While only 32% of the river basins were affected by this nematode, they correspond to 74% of the total wetted area. Significant differences in infection levels among water body types were found with lakes and transitional waters yielding the highest values, which can be attributed to the proportions of juvenile (total length, L(T) < 300 mm) A. anguilla caught. There were no significant differences in infection levels between water body types for adult A. anguilla or between sexes for any water body type. Prevalence was significantly lower in juvenile compared with adult A. anguilla captured in rivers and a positive correlation between infection levels and host size-classes was found. Future efforts should focus on monitoring the spread of A. crassus infections and assessing the swimbladder health of A. anguilla in Ireland.
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Affiliation(s)
- G Becerra-Jurado
- Inland Fisheries Ireland, Research Section, Swords Business Campus, Swords, Co., Dublin, Ireland
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White P, McHugh B, Poole R, McGovern E, White J, Behan P, Foley B, Covaci A. Application of congener based multi-matrix profiling techniques to identify potential PCDD/F sources in environmental samples from the Burrishoole Catchment in the West of Ireland. Environ Pollut 2014; 184:449-456. [PMID: 24121420 DOI: 10.1016/j.envpol.2013.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/16/2013] [Accepted: 09/18/2013] [Indexed: 06/02/2023]
Abstract
Homologue and congener profiles of PCDD/Fs in eels, passive sampler and sediment extracts from the Burrishoole, a rural upland catchment on the western Irish seaboard were compared with potential PCDD sources. ΣPCDD/F levels in eels ranged from 2.9 to 25.9 pg g(-1) wet weight, which are elevated compared to other Irish locations. The OCDD congener dominated the pattern of ΣPCDD/Fs in all matrices from Burrishoole. Passive samplers were successfully deployed to identify for the first time the presence in the water column of PCDD/Fs and dimethoxylated octachlorodiphenyl ether (diMeOoctaCDE), impurities found in pentachlorophenol (PCP) production. Principal component analysis (PCA) identified similarities between PCDD/F profiles in technical PCP mixtures and environmental samples from the Burrishoole region. Results strongly suggest residual PCDD contamination associated with historic local use of a dioxin contaminated product in the catchment area, with pentachlorophenol a strong candidate.
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Affiliation(s)
- P White
- Marine Institute, Rinville, Oranmore, Galway and Newport, Mayo, Ireland; School of Chemical and Pharmaceutical Sciences, Dublin Institute of Technology, Kevin St., Dublin 8, Ireland.
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Keenan K, Bradley CR, Magee JJ, Hynes RA, Kennedy RJ, Crozier WW, Poole R, Cross TF, McGinnity P, Prodöhl PA. Beaufort trout MicroPlex: a high-throughput multiplex platform comprising 38 informative microsatellite loci for use in resident and anadromous (sea trout) brown trout Salmo trutta genetic studies. J Fish Biol 2013; 82:1789-1804. [PMID: 23731137 DOI: 10.1111/jfb.12095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/04/2013] [Indexed: 06/02/2023]
Abstract
A flexible panel consisting of 38 informative microsatellite markers for Salmo trutta is described. These markers were selected from a pool of over 150 candidate loci that can be readily amplified in four multiplex PCR groups but other permutations are also possible. The basic properties of each markers were assessed in six population samples from both the Burrishoole catchment, in the west of Ireland, and Lough Neagh, in Northern Ireland. A method to assess the relative utility of individual markers for the detection of population genetic structuring is also described. Given its flexibility, technical reliability and high degree of informativeness, the use of this panel of markers is advocated as a standard for S. trutta genetic studies.
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Affiliation(s)
- K Keenan
- Institute for Global Food Security, School of Biological Sciences, Queen's University, Belfast, UK
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Poullis M, Poole R. Reply to Sahni and Bhatia. Eur J Cardiothorac Surg 2012. [DOI: 10.1093/ejcts/ezs233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Bailey J, Poole R, Ruben S, Robinson CA. Is alcohol consumption irrelevant to outcome in anxiety and depression? Br J Psychiatry 2012; 201:326; author reply 326-7. [PMID: 23028085 DOI: 10.1192/bjp.201.4.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
The extent to which religion and spirituality are integrated into routine psychiatric practice has been a source of increasing controversy over recent years. While taking a patient's spiritual needs into account when planning their care may be less contentious, disclosure to the patient by the psychiatrist of their own religious beliefs or consulting clergy in the context of treatment are seen by some as potentially harmful and in breach of General Medical Council guidance. Here, Professor Rob Poole and Professor Christopher Cook debate whether praying with a patient constitutes a breach of professional boundaries in psychiatric practice.
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Affiliation(s)
- Rob Poole
- Department of Mental Health, Glyndwr University, Croesnewydd Road, Wrexham LL13 7YP, UK.
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Lewandowski AJ, Lazdam M, Davis E, Poole R, Diesch J, Francis J, Augustine D, Banerjee R, Suttie J, Neubauer S, Leeson P. 110 Myocardial systolic strain and subclinical atherosclerosis in young adult life. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lewandowski AJ, Lazdam M, Davis E, Poole R, Diesch J, Francis J, Neubauer S, Lucas A, Singhal A, Kelly B, Leeson P. 59 Short term elevation of cholesterol level in neonatal life and long term changes in aortic stiffness: insights from use of intravenous lipids. Heart 2011. [DOI: 10.1136/heartjnl-2011-300198.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
BACKGROUND There is concern over the methods used to evaluate antipsychotic drugs. AIMS To assess the clinical relevance of findings in the literature. METHOD A systematic review identified studies of antipsychotics that used the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS). A published method of translating these into Clinical Global Impression - Change scale (CGI-C) scores was used to measure clinical relevance. RESULTS In total 98 data-sets were included in the BPRS analysis and 202 data-sets in the PANSS analysis. When aggregated scores were translated into notional CGI-C scores, most drugs reached 'minimal improvement' on the BPRS, but few reached that level for PANSS. This was true of both first- and second-generation drugs, including clozapine. Amisulpride and olanzapine had better than average CGI-C scores. CONCLUSIONS Our findings show improvements of limited clinical relevance. The CGI-C scores were better for the BPRS than for the PANSS.
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Affiliation(s)
- Peter Lepping
- Wrexham Academic Unit, Technology Park, Croesnewydd Road, Wrexham LL13 7YP, UK.
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