Poster presentations

• Dr Padma Gopinath - Locum Consultant Psychiatrist / Care Home In Reach Team NPT - Swansea Bay University Health Board
• Dr Hari Mohanasundaram - Clinical Fellow In Old age Psychiatry 
• CHIRT Members - Neath Port Talbot area
• Audit Department - Kasey Butler and Marie Williams

Our aim

To reduce or stop inappropriate prescriptions of antipsychotics in older adults with dementia or functional illness residing in the local care homes in NPT.

To ensure adequate and timely review of the antipsychotic medications.

• Dr Faryal Sohail
• Dr Harry Chamberlain
• Dr Padmavathy Gopinath
• Dr Graham O’Connor 

Our aim

To conduct a clinical audit to measure the rates of resuscitation discussion and DNAR form completion for all older patients in Hywel Dda Psychogeriatric Units.

• Dr Areej Rasheed
• Dr Muhammad Saqib Shah
• Dr Amr Romeh
• Dr Raja Adnan Ahmed 

Our aim

• Dr Grace Goss
• Priya Gowda
• Danika Rafferty

Introduction

One junior doctor (CT1 or equivalent) is allocated to cover the ward whilst balancing their other training needs and clinical commitments. The inpatient ward is based in a community hospital with no onsite medical team. The patients mostly have complex medical needs and multiple comorbidities.

Objectives

1. This project aimed to review the medical cover available to an Old Age Psychiatry inpatient ward.
2. To discuss with ward staff their view for potential improvements and areas of clinical development.
3. To review the potential of a Full Time Nurse Practitioner role on the ward.

• J Williams
• R Rahman
• G Johns
• A Ahuja
• B Whistance
• P Wright

Background

COVID-19 rapidly altered the way in which  healthcare is delivered across the National Health  Service (NHS) and there has been a rise in the use  of digital innovations e.g., video consulting (VC).  Child and Adolescent Mental Health Services  (CAMHS) adapted VC to maintain the connection  between clinicians and patients during this  unprecedented time. 

Research aim

To understand the perceptions, usage, and  acceptability of VC as an alternative to face-to-face  in the future of CAMHS.

Bethan Whistance, Poppy Wright, Jessica Williams, Megan Whistance, Gemma Johns and Alka Ahuja

Background

The last year has seen an extraordinary shift in working practices and workplace environments within the  National Health Service (NHS). This shift has occurred with advancements in digital interventions including the introduction of Video Consulting (VC). Clinicians and patients within the NHS had to adjust to VC at pace;  challenging the culture witnessed within Mental Health and Psychiatry which typically utilised face-to-face  consultations to facilitate therapeutic relationships and observe body language.

Research aim

To investigate the benefits, challenges and sustainability of VC, while exploring the VC experience  from patients, families and clinicians.

Jennifer Rankin

Background

As a result of COVID-19 restrictions, junior doctors working in psychiatry have struggled to facilitate CASC practice. Traditionally, trainees would arrange face-to-face groups to practice simulated scenarios.  However, the pandemic has limited these opportunities. Therefore, an evening Zoom CASC practice group was developed to address this need.

Junior doctors across Wales signed up to practice via a Whatsapp group. Practice groups ran Monday-Thursday from 8pm. This was supervised by a small group of senior doctors who volunteered their time. One higher trainee coordinated the sessions via an online spreadsheet to coordinate trainees, supervisors and topics for practice.

This group ran for August 2020, January 2021 and May 2021 CASC sittings. This method of practice was subsequently evaluated using an online questionnaire.

Professor Christopher Marshall, Dr Brian Huey, Dr Patrick Fielding, Dr Rui Zheng, Dr Chineze Ivenso

Background

Key aspirations for the Dementia Action Plan Wales are to increase the number of people formally diagnosed with dementia by three percentage points annually to improve early diagnosis and timely interventions.

Dr Alexander McDermott CT3, Dr Jennifer Rankin ST5. Cwm Taf Morgannwg University Health Board

Background

Initial planning for Covid 19 pandemic involved difficult decision making for many clinicians. The Older Adult Mental Health Wards were relocated and merged at Angelton Clinic, an off-site unit separate to Princess of Wales Hospital. Therefore, it was essential that patients had a clear escalation of care plans, made by senior clinicians who know the patients well, available to those working out of hours. This would aid decision making by those who may not know the patients' background to feel comfortable to make timely and appropriate decisions.

GMC guidance recommends that if a patient has an advanced, progressive, incurable condition then the MDT must plan ahead to ensure safe and effective care.1 Studies have also found that patients view escalation planning a positive component of their care2 . This was of particular relevance during the Covid 19 Pandemic.

Dr Asha Dhandapani CT3, Dr Sathyan Soundararajan CT3, Dr. Catherine Baker Consultant Psychiatrist, Dr Rajvinder Sambhi Consultant Psychiatrist

Introduction

Novel coronavirus 2019 was first described in December 2019 in Wuhan in China. Since those initial few cases, it has rapidly proliferated to a global pandemic, putting an inordinate amount of strain on healthcare systems around the world. The Heddfan unit is an inpatient general adult/ older person’s psychiatric unit based on the site of Ysbyty Wrexham Maelor in North Wales.

During this pandemic, various changes have been made to the provision of psychiatric services in Betsi Cadwaladr University Health Board (BCU) to combat the crisis. The Heddfan unit has been converted into Older person’s mental health unit in total. We recently had an increase in the number of patients turning positive for COVID infection. We also had a majority of the staff being off sick/ unwell and Covid positive. I believe that the technique of donning and doffing if followed as per PHE guidelines would be of help in both preventing the infection and also would be in terms of care and safety to both patients and staff.

Cristie Howells, Mental Health Nurse & Independent Prescriber. Dr Chakrabarti, Consultant Psychiatrist, The Care Home Liaison Service, Cardiff & Vale UHB

Background

NICE (2015) recognise that antipsychotic medications can be used to assist in managing the biological and psychological symptoms of dementia (BPSD), such as; agitation, aggression, severe distress and psychosis. However, the Banerjee Report (2009) outlines the complexities of using antipsychotic medication to manage BPSD. The report indicates antipsychotic medication is overused, and that often the potential benefit of the drugs is outweighed by their adverse effects.

Dr Harish Reddy, Consultant Psychiatrist

Aim

The aim of the audit was to identify patients at risk of developing Metabolic Syndrome who are on Clozapine in the South Ceredigion Community Mental Health Team.

Background

Anyone who has three of the following attributes has Metabolic Syndrome. A large waist size (greater than 40 inches in men or 35 inches in women), high blood pressure (130/85 mmHg or higher), high triglycerides - a form of fat in the blood (150 mg/dL or higher), high blood sugar (a fasting level of 100 mg/dL or higher). Patients receiving Clozapine should be regularly monitored under clinical review particularly in relation to side-effects of the drug and maintain minimum standards of review of both physical and clinical investigations once a year.

Dr Laura Williams, CT3 Psychiatry. Dr Caroline Mulligan, Consultant Forensic Psychiatrist. Betsi Cadwaladr University Health Board (BCUHB, UK).

Background 

• Clozapine is an antipsychotic medication used in treatment-resistant schizophrenia. It is the gold standard treatment for psychotic disorders and has a 50% response rate in previously treatment-resistant patients.
• The use of Clozapine must be closely monitored due to the frequency and severity of its own adverse effects.
• Our aim in completing this audit was to ensure that we are compliant with our Trust guidelines on side-effect monitoring, and ultimately to ensure that any patients with side effects are having these treated.

Dr Laura Williams CT3, Dr Vikram Bhangu CT2, Dr Colin White Consultant Psychiatrist.

Introduction

Insomnia is defined as a ‘disturbance of normal sleep patterns commonly characterised by difficulty in initiating sleep and/or difficulty maintaining sleep’. We know that there are variations in sleep length and quality both for an individual night-to-night and between individuals. However, the majority of us will need between 7-9 hours per night to feel rested and refreshed.

Primary insomnia should be differentiated from insomnia with a clear cause such as substance abuse, physical and/or psychiatric comorbidities, as the management may be different. It is indicated by the WHO that 52% of people reporting a sleep problem have a well-defined mental health disorder.

Sleep disturbance can result in daytime fatigue causing distress and impairment in both social and occupational functional leading to a reduced quality of life. Hypnotic drug therapy should be kept for use only when simple non-pharmacological options such as sleep hygiene advice have been trialled and found to be ineffective, and the management of existing co-morbidities has been optimised. They should also only be used in people with insomnia who experience severe insomnia with significant interference with daily life and functioning.

The most commonly prescribed medications for insomnia are short-acting benzodiazepines and Z-drugs such as Zopiclone. In addition, up to 40% of people with insomnia will self-medicate with hypnotics available over the counter such as sedative antihistamines. One of the main issues with the use of benzodiazepines and Z-drugs is their propensity for tolerance development with prolonged use, leading to dependence and withdrawal on discontinuation. ‘Rebound insomnia’ is also a potentially unpleasant phenomenon for those who have managed to stop taking them. These risks can be lessened when restricting use to those with severe insomnia only, by using low doses and not continuing treatment beyond four weeks duration.

NICE recommend selecting the cheapest option when prescribing unless the patient experiences an adverse effect to the first-line treatment. Zopiclone is currently the cheapest in terms of acquisition costs for an adult dose (7.5mg) at £0.16.

We have noticed that inpatient psychiatric units across North Wales we do not follow a protocol when prescribing hypnotics, and therefore the advice and treatment we are giving to our patients is not always uniform and may not be evidence-based. We wanted to complete this audit to understand deficits in our prescribing practices and attempt to improve these for the benefit of our patients.

Dr. R Malhotra, Trainee in Psychiatry of Intellectual Disabilities Dr. F Farquhar, Consultant Psychiatrist.

Introduction

VTE is a condition in which a blood clot (thrombus) forms in a vein, most commonly in the deep veins of the legs, known as a deep vein thrombosis (DVT).

The thrombus can dislodge from its original site and travel in the blood (embolism).

If it becomes lodged in the lungs, a condition known as a pulmonary embolism (PE) arises and can cause sudden death.

Hospital-acquired thrombosis is avoidable and unfortunately kills patients under our care.

From May 2015 NHS organisations in Wales are expected to report the number of VTE cases associated with hospital admissions which are possible hospital-acquired thrombosis (HAT) per calendar month.

Dr Deni Mohan, ST6 Care Home Liaison team, Cardiff UHB, Dr Arpita Chakrabarti, Consultant Care Home Liaison, Cardiff UHB, Craig Walters Team Leader Care Home Liaison team, Amy Smith Care Home Liaison nurse and Team Coordinator.

Introduction

The COVID-19 pandemic raises challenges for care home residents, their families and the staff that look after them. Discharge from inpatient units to long-term care can be particularly challenging given the current circumstances. As we all know care home residents are regarded as shielding and are therefore the most vulnerable to the effects of COVID-19. In order to safeguard resident’s health it is essential that robust controls are in place to mitigate the risk of transfer and spread of infection within the closed setting.

Dr Jessica Foster ST4, Dr Jennifer Rankin ST5.

Introduction

Cardiff CASC Training (CCT) provides structured and formal training for the CASC exam for Wales trainees, in conjunction with the Wales Deanery. First established in 2012, CCT has delivered face-to-face mock CASC exams for the past 8 years. Feedback from candidates and examiners has been excellent, with extremely positive outcomes in terms of improvement in CASC pass rate for candidates.

Burns, L., Sergio Da Silva, A., & John, A.

Introduction

Patient factors such as demographics, socioeconomic status, and education can unintentionally impact mental health-related clinical decisions. Understanding the extent to which these non-clinical patient factors (NCpF) influence clinical decision-making is imperative to minimising errors in diagnosis or treatment caused from internal biases.

Aim

To use a mixed-methods design to understand the impact of NCpF on mental-health related diagnostic, treatment and referral decisions.

Marcos DelPozo-Banos, Ann John, David Gunnell, Michael Dennis Jonathan Scourfield, David V Ford, Keith Lloyd.

Introduction

Among young people, suicide is one of the leading cause of death worldwide. Suicide rates of 0.4 and 1.5 per 100,000 population for 5-14 years-old are reported by the WHO. In the last 50 years, suicide research has seen slow progress and innovation, and a scarcity of longitudinal studies [Franklin 2017]. Longitudinal studies of patterns of healthcare contacts in under 25 year-olds who die by suicide are scarce. Existing studies do not simultaneously explore healthcare routinely collected data across all settings.

Wright, P., Williams, J., Johns, G., Lees, M., Ahuja, A; TEC Cymru, Aneurin Bevan University Health Board (ABUHB).

Background

Covid-19 put the physical and psychological health and well-being of the nation at risk. Technology Enabled Care (TEC) Cymru designed and implemented a new National Video Consulting (VC) Service in Wales as an emergency response. The VC service was offered to all primary, secondary and community care services, with a large uptake among mental health and psychiatry specialties (11%). Emerging research suggests that symptoms of depression, anxiety and stress are common reactions to the Covid19 outbreak. It is therefore important that the use and acceptability of innovations such as VC are robustly evaluated so that they can be confidently utilised within mental health services.

Dr Sathyan Soundararajan CT3, Dr Asha Dhandapani CT3, Dr Rajvinder Sambhi Consultant Psychiatrist.

Introduction

Violence, agitation and aggressive behaviour refer to behaviours that can cause harm to others or to the person with those behaviours, regardless of whether it is verbal, physical and intentional. These behaviours are common in health care settings.

From 2013–2014, 68,683 assaults were reported against NHS staff in England, 69% of these were within mental health and learning disability unit.

Rapid tranquillisation is to be used in situations where psychological and behavioural approaches, such as ‘de-escalation’, have failed. It is a treatment of last resort. It is a restrictive treatment and therefore needs to be monitored closely to ensure its correct use, and to ensure patient safety.

Rapid tranquillisation is defined as, “use of medication by the parenteral route (usually intramuscular or, exceptionally, intravenous) if oral medication is not possible or appropriate and urgent sedation with medication is needed”.

There was a national audit on rapid tranquillisation in 2007 which made several recommendations; including the importance of monitoring following rapid tranquillisation, which was found to be one of the areas of poorer performance and this audit/QIP aims to find out if their recommendations have been followed.

Sze Chim Lee, Ann John, Susan Solomon, David Crepaz-Keay, Shari McDaid, Alec Morton, Gavin Davidson, Tine Van Bortel, Antonis A. Kousoulis. 

Background

The immediate and potential long-term impacts of the unprecedented coronavirus disease (COVID-19) on mental health, suicide and self-harm have not been widely addressed (Holmes et al., 2020; Torales et al., 2020). In relation to the extensive lockdown measures implemented, public mental health were expected to deteriorate in tandem with these dramatic changes at personal (e.g. restricted freedom), social (e.g. due to isolation and distancing) and economic level (e.g. unemployment and financial hardship), particularly for vulnerable individuals (Gunnell et al., 2020; Holmes et al., 2020).

Loneliness, the self-perceived deficiency of an individual’s social relation network in quantitative or qualitative terms, has been identified as an important factor associated with suicidal thoughts and behaviours and the effect of loneliness on suicidal thoughts and behaviours is more prominent in young adults because they are experiencing periods where drastic changes in social status occur resulting in elevated loneliness (McClelland et al., 2020). Social isolation and loneliness linked to health protection measures similar to those taken in the COVID-19 pandemic resulted in a deterioration of the mental health of children and young people (Loades et al., 2020). Additionally, perceived stress and poor coping mechanisms are associated with suicidal behaviours in young people (e.g., Linda et al., 2012).

A UK-wide lockdown was announced on March 23rd 2020 which included instructions to the general population to stay at home, socially/physically distance and to self-isolate if they had symptoms. This was accompanied by guidance regarding movements outside the home for exercise and grocery shopping. These restrictions were fully in place until May 13th when they were gradually eased. Given the potential for such measures to be implemented in any further waves of COVID-19 or other pandemics, it is important to understand the effects of these measures on mental health and well-being in order to mitigate them in the future and address them currently.

This study aimed to explore the risk factors for suicidal thoughts and self-harm in response to the COVID-19 pandemic in the UK population using a repeated cross-sectional online population survey representative of the adult UK population. We assessed the effects of known amenable psychological risk factors for young adults including loneliness and coping, and other sociodemographic potential confounders.