Døgnvariasjoner for innleggelser ved akuttpsykiatriske enheter

Aim: The aim of this study was to investigate diurnal variations of admissions in acute psychiatry. Method: The registration of 2763 submissions were conducted from 01.04.15–31.12.17 at the University Hospital of North-Norway by completing a form for every admission. Results: The results revealed that a majority of the admissions took place at evening and nighttime. There were significantly (p = .001) more admissions at evening and night. Results revealed that 21,[A1] 5 % (539) of the admissions were between 00:00–08:00, whereas 27,5 % (758) of the admissions were between 08:00–16:00, and 51 % (1409) of the admissions were between 16:00–00:00. Conclusion: The causes behind this distribution of the admissions should be investigated in future studies. Future studies should ask the patients about the causes of the late admissions. Keywords: diurnal variations, admissions, acute psychiatry

Counting ECGs in acute psychiatry – The patients' price for junior doctors' rotations

AimsOn 05/08/20, when a new cohort of doctors rotated onto an acute ward, (John Dickson Ward, Maudsley Hospital, London) a new handover tool on MS Teams was introduced, which replaced previously used MS Word document. The new handover tool can be accessed and edited by any of the users in the team. We hypothesised that the introduction of an interactive, live-updated tool would help improve physical health monitoring for patients, especially compliance with ECG taking. The aim of this project was to test this hypothesis.MethodAuthors have reviewed electronic documentation of patients admitted to and discharged from John Dickson Ward between 01/04/2020 and 24/12/2020. Evidence of whether an ECG was performed, was offered but declined by the patient, or was not offered were noted in the final audit. Patients were divided into 3 groups: (1) Patients admitted and discharged from 01/04/20 – 05/08/2020; (2) Patients admitted and discharged from 05/08/2020 – 24/12/20, and (3) Patients admitted before the intervention date, but discharged after the date (i.e., the period when new junior doctors had rotated onto the ward). Fifty patient records were identified in Group 1, fifty in Group 2, and 18 in Group 3.ResultSurprisingly, the percentage of patients who had a documented ECG did not improve after the intervention, with 37/50 (74%) of patients having an ECG in Group 1, and 37/50 (74%) of patients having an ECG in Group 2. However, an incidental finding was made that significantly fewer patients received ECGs during the changeover period (Group 3), with only 6/18 (33%) of patients receiving ECGs. The percentage of patients who were not offered ECGs also increased during the changeover period, with 2/50 (4%) in Group 1, and 3/18 (17%) in Group 3 not being offered.ConclusionThis incidental finding highlights the challenges associated with the junior doctor changeover period. Much time is needed for doctors to adjust to their new surroundings and methods of working, and this may result in basic elements of patient care being overlooked. We surmise that other elements, such as ensuring all patients having regular blood tests and physical examinations, may also be of a lower standard during this period. There is scope for future audits to address this, and for future quality improvement projects to implement changes ensuring medical care remains at a high standard during junior doctor changeover periods.

Evaluating virtual role play based learning to improve the confidence and competence of Junior Doctors undertaking on call shifts in inpatient Psychiatry

AimsTo enable junior doctors to practice their clinical skills in managing psychiatric emergencies via virtual role plays, and to gain confidence and competence in their skills in acute psychiatry. Lecture based learning about psychiatric emergencies is a part of the induction programme for all junior doctors starting their placements however practical learning and practice of skills in this area is not. The COVID-19 pandemic has further exacerbated this issue by providing an additional challenge to the delivery of face to face teaching for junior doctors both in clinical and educational settings.MethodThe author offered a virtual role play based teaching session to two cohorts of Junior Doctors (GP trainees and foundation trainees) who were starting their psychiatric hospital placements at Surrey and Borders Partnership. The virtual sessions were conducted over Microsoft teams. This session had been run once before as face to face teaching (F2F) in January 2019 (N = 9) prior to the COVID-19 pandemic. Data from this session were compared to data obtained from the virtual sessions in November 2020 and January 2021 (N = 16).Pre and post study questionnaires were administered via Microsoft Forms. Each session lasted 1 hour and consisted of 3 different role play scenarios based around acute psychiatric emergencies. One junior doctor volunteer acted as the ‘patient’ in each scenario and another volunteer as the ‘doctor’. The other participants all acted as observers. Each scenario lasted 10 minutes with ten minutes for feedback from the researcher afterwards using the ALOBA framework.Categorical, ordinal data were collected using a Likert scale and general qualitative feedback was also gathered.ResultThe questionnaire return rate was 100% for F2F teaching and 57% for virtual teaching. 100% of participants felt that F2F role play was an acceptable way to practice skills in acute psychiatry vs 75% of participants who felt this about virtual role play. 100% of participants found that F2F role play was ‘quite’ or ‘very’ effective in improving their confidence and perceived competence in acute psychiatry vs 88% of participants who felt this about virtual role play.ConclusionVirtual role play based learning is an acceptable and effective method in improving the confidence and perceived competence of junior doctors undertaking on call shifts in inpatient psychiatry but it appears to be less effective than face to face role play based learning. The researcher will act upon the qualitative feedback obtained which suggested ways in which the virtual session could be improved.

Graves’ disease presenting with hypomania and paranoia to the acute psychiatry service

This manuscript describes the case of a young woman, with no prior psychiatric history, who developed hypomania and paranoia as the principal presenting features of Graves’ disease. After starting treatment with carbimazole and propranolol, symptoms resolved without the use of antipsychotic drugs. Close liaison between psychiatry and endocrinology services was essential. This demonstrates that treating underlying thyrotoxicosis in patients presenting with psychiatric symptoms may lead to recovery without the use of antipsychotic medication. While agitation, irritability and mood lability are well-recognised thyrotoxic symptoms, psychosis is a rare presenting feature of Graves’ disease. All patients with agitation, delirium or psychiatric symptoms should have thyroid function checked as part of initial tests screening for organic disease. In new or relapsing psychiatric conditions, it is important to ask patients, their carers or relatives about symptoms of hypothyroidism or thyrotoxicosis.

Voluntary and involuntary admissions with schizoaffective disorder: do they differ from schizophrenia?

Objectives: Schizoaffective disorder and schizophrenia are common presentations to psychiatry services. Research to date has focussed on hypothesised biological differences between these two disorders. Little is known about possible variations in admission patterns. Our study compared demographic and clinical features of patients admitted voluntarily and involuntarily with diagnoses of schizoaffective disorder or schizophrenia to three psychiatry admission units in Ireland. Methods: We studied all admissions to three acute psychiatry units in Ireland for periods between 1 January 2008 and 31 December 2018. We recorded demographic and clinical variables for all admissions. Voluntary and involuntary admissions of patients with schizoaffective disorder were compared to those with schizophrenia. Results: We studied 5581 admissions to the study units for varying periods between January 2008 and December 2018, covering a total of 1 976 154 person-years across the 3 catchment areas. The 3 study areas had 218.8, 145.5 and 411.2 admissions per 100 000 person-years, respectively. Of the 5581 admissions over the study periods, schizoaffective disorder accounted for 5% (n = 260) and schizophrenia for 17% (n = 949). Admissions with schizoaffective disorder were significantly more likely to be female and older, and less likely to have involuntary admission status, compared to those with schizophrenia. As first admissions were not distinguished from re-admissions in this dataset, these findings merit further study. Conclusions: Admissions with a schizoaffective disorder differ significantly from those with schizophrenia, being, in particular, less likely to be involuntary admissions. This suggests that psychotic symptoms might be a stronger driver of involuntary psychiatry admission than affective symptoms.