Mental health diagnoses in adults with phenylketonuria: a retrospective systematic audit in a large UK single centre

Abstract Background Recently published European Society for Phenylketonuria (ESPKU) guidelines have recommended a lifelong diet with phenylalanine (Phe) control ≤ 600 μmol/L for phenylketonuria (PKU) patients. This study aimed to identify whether PKU adult patients are at a higher risk of mental health diagnoses if their 2-year average Phe level is higher than the ESPKU European guidelines. Published studies identified by a literature review showed that related studies have been published in American and European PKU study populations but not in the United Kingdom (UK) study populations. Previous studies also involved a smaller number of participants due to this being a rare disease. Results We undertook a retrospective audit at a single large PKU centre in the UK. 244 adult PKU patients at the centre were included, 220 of which had a recorded Phe level. Approximately 75% of the patients in this study did not meet the ESPKU European guidelines for Phe control. A systematic search of the electronic patient record was undertaken looking for mental health diagnoses. Compared to two-year average Phe levels ≤ 600 μmol/L, PKU adult patients with two-year average Phe levels > 600 μmol/L were more likely to have diagnoses of low mood, depression, anxiety, or mood swings, but only low mood reached statistical significance (p < 0.05). Conclusions PKU patients with two-year average Phenylalanine levels greater than ESPKU guidelines may be at greater risk of mental health diagnoses and symptoms. Many of these adult PKU patients will be lost to follow-up, and therefore may be receiving treatment for mental health conditions in the community. Multicentre UK studies and international collaborations are required to overcome low participant numbers in the study of this rare disease.

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Assessing DNA rates for new referrals in older adults

BJPsych Open ◽

10.1192/bjo.2021.486 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S179-S179

Author(s):

Aamina Cheema ◽

Nasir Pasha ◽

Giorgi Gurieli

Keyword(s):

Mental Health ◽

Older Adults ◽

Older Adult ◽

Waiting Time ◽

Initial Assessment ◽

National Guidelines ◽

Asthma Attack ◽

Retrospective Audit ◽

Initial Appointment ◽

The Uk

AimsTo assess DNA rates for initial assessment medical appointments offered for new referrals within an Older Adults CMHT.To establish any correlation between waiting time and DNA rates.To establish if the initial appointments offered were in keeping with the National guidelines (18 weeks) and our local Trust policy (1-4 weeks).BackgroundIn the Uk 15% of adults 60 and above suffer from a mental disorder. Despite the increasing mental health burden, analysis indicate that a quarter of mental health trust received less investment from 2017 to 2018. Financial pressures have also increased appointment waiting time. The NHS has stated that by 2023 there will be a 4-week waiting time for older adult mental health services. Current national guidelines state that initial referrals should be seen within 18 weeks.MethodThis is a retrospective audit looking at all first time referrals to an Older Adult CMHT in East Birmingham. 110 patients were included in this audit. Factors recorded included age, gender, reason for referral, waiting time for appointment, and whether this complies with guidelines.Electronic patients' notes (RIO) were used for data collection.ResultOut of 110 new referrals 11 were not offered any appointments. Out of the remaining 99, 13 cancelled and 8 did not attend.In total, 78 attended the initial appointment offered, out of which 77 were seen within 18 weeks as per national guidelines. 43 patients were seen within the 4-week period (trust policy). 1 patient was offered an appointment at 19 weeks and 3 days from the referral date. The patients who did not attend their appointments were followed up except for one, to find out the reasons of the DNA. This included 2 (physically unwell), 1 (unaware of appointment), 1 (refused), 1 (forgot), 1 (couldn't get to clinic), 1 (asthma attack). Another appointment was offered to those who could attend.ConclusionThere was no significant correlation between a longer waiting time and an increased DNA rate for first appointments. Even though the time for an initial appointment was within the NHS guidelines, only 56% of the appointments met our Trust's policy of a 4 week wait.When discussing the results with the relevant team it was clear that a number of factors affected the waiting time including: number of available clinicians and a large catchment area.

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Primary Care Utilization and Mental Health Diagnoses Among Adult Patients Requiring Interpreters: a Retrospective Cohort Study

Journal of General Internal Medicine ◽

10.1007/s11606-012-2159-5 ◽

2012 ◽

Vol 28 (3) ◽

pp. 386-391 ◽

Cited By ~ 9

Author(s):

Priscilla M. Flynn ◽

Jennifer L. Ridgeway ◽

Mark L. Wieland ◽

Mark D. Williams ◽

Lindsey R. Haas ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adult Patients ◽

Care Utilization ◽

Mental Health Diagnoses ◽

Primary Care Utilization

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Depression in adults

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738020978681 ◽

2021 ◽

Vol 14 (3) ◽

pp. 176-184

Author(s):

Claire Norman ◽

Lachlan Fotheringham

Keyword(s):

Mental Health ◽

Mental Disorder ◽

Common Mental Disorder ◽

Physical Symptoms ◽

Low Energy ◽

Special Consideration ◽

Low Mood ◽

Wide Range ◽

The Uk ◽

Different Cultures

Depression is a persistent state of low mood, low energy or anhedonia and is considered a common mental disorder. It is associated with a wide range of significant emotional, psychological and physical symptoms. It can have a significant impact on people’s functioning, and mental ill health is estimated to cost the UK economy £94 billion per year. An estimated 40% of GP consultations are about mental health, and it is important that depression is appropriately diagnosed and managed. This article reviews the most recent National Institute for Health and Care Excellence guidelines and also gives special consideration to managing depression alongside physical comorbidities and in patients from different cultures.

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Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK

10.31234/osf.io/sf7b6 ◽

2021 ◽

Author(s):

Katherine Seaton Young ◽

Kirstin Lee Purves ◽

Christopher Huebel ◽

Molly Davies ◽

Katie Thompson ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Population Level ◽

Female Gender ◽

Anxiety Symptoms ◽

Ptsd Symptoms ◽

Symptom Change ◽

Global Ratings ◽

Mental Health Diagnoses ◽

The Uk

Background: The COVID-19 pandemic is a novel population-level stressor. As such, it is important to examine pandemic-related changes in mental health and to identify which individuals are at greatest risk of worsening symptoms.Methods: Online questionnaires were administered to 34,465 individuals in the UK, recruited from existing cohorts or via social media. Around one third (n = 12,718) with prior diagnoses of depression or anxiety completed pre-pandemic mental health assessments, allowing prospective investigation of symptom change. We examined changes in depression, anxiety and PTSD symptoms using prospective, retrospective and global ratings of change assessments. We also examined the effect of key risk factors on changes in symptoms.Outcomes: Prospective analyses showed small decreases in depression (PHQ-9: - .43 points) and anxiety symptoms (GAD-7: -.33 points), and increases in PTSD symptoms (PCL-6: .22 points). Conversely, retrospective analyses demonstrated large significant increases in depression (2.40 points) and anxiety symptoms (1.97 points) and 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Using both prospective and retrospective symptom measures, regression analyses demonstrated that worsening depression, anxiety and PTSD symptoms were associated with i) prior mental health diagnoses, ii) female gender; iii) young age, and iv) unemployed or student status.Interpretation: We highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously-reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias underestimating prior symptom severity.

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Evaluation of a mental health first aid workshop for healthcare professionals

BJPsych Open ◽

10.1192/bjo.2021.67 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S1-S1

Author(s):

Sara Abou Sherif ◽

Sachin Patel

Keyword(s):

Mental Health ◽

Healthcare Professionals ◽

Statistical Significance ◽

Effective Means ◽

First Aid ◽

Mental Health First Aid ◽

Mental Health Nurses ◽

Strongly Agree ◽

Training Programmes ◽

The Uk

AimsAnnually, 1 in 4 people in the UK will experience a mental health problem. Alongside the approach of increasing awareness of the issue amongst the general population, there is a drive to deliver training and education on the recognition and management of mental health crises. Limited resources exist to aid healthcare professionals in delivering mental health first aid (MHFA), with the vast majority focussing on lengthy training courses. Small group problem-based learning (PBL) is utilised widely in medical education and this modality offers advantages in deliverability, audience participation and experiential learning. Our aim was to deliver and explore the effectiveness of a PBL MHFA workshop to various healthcare professionals.MethodAs part of an Emergency Medicine Mental Health Education day, we delivered four 30-minute PBL MHFA workshops. These involved an introduction to MHFA, followed by an interactive discussion of 4 mental health simulated cases, whereby participants anonymously answered a range of questions using the web-based platform Mentimeter. We devised a simple MHFA A,B,C,D,E acronym to bring structure to problem solving. Pre- and post-workshop questionnaires were used to assess outcomes using Likert scales to measure various aspects of MHFA (1 = strongly disagree and 5 = strongly agree). Statistical significance was calculated using T-Test with P < 0.05 defining statistical significance.ResultA total of 28 professionals attended the workshops, 20 (72%) completed both the pre and post workshop questionnaire. 19 (76%) were nurses (5 Registered Mental Health Nurses and 14 Registered General Nurses), 3 (12%) were doctors, 2 (8%) were HCA's and 1 was a policeman. 15 (75%) of the participants reported historically having had the need to deliver MHFA but only 3 (15%) had previously received training. After the workshop, participants reported significantly increased understanding [3.0 to 4.3 (p < 0.05)] and confidence in delivering MHFA [3.05 to 4.30 (p < 0.05)]. There was significantly improved confidence in assessing risk [3.03 to 4.05], calling for appropriate help [3.45 to 4.35] and de-escalation techniques [3.05 to 4.15].ConclusionTo our knowledge this is the first mini PBL-based MHFA workshop. We have demonstrated that the PBL workshop setup is an effective means to deliver training on MHFA. We recognise the importance of MHFA training reaching a larger audience and its potential value if incorporated into national healthcare training programmes and made available to the general public.

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