A longitudinal evaluation of the impact of the COVID-19 pandemic on a cohort of patients treated with clozapine.

OBJECTIVES: We previously demonstrated that three months into the COVID-19 pandemic, the impact on individuals with treatment-resistant psychotic disorders was modest. Here, we examined and compared the psychological and social impact of the COVID-19 pandemic on the same patient cohort 12 months after their initial study engagement. METHODS: Semi-structured interviews were conducted with 54 individuals (85.7% response rate) between June 12 and July 29, 2021, 12 months after their initial interviews. Participants' subjective experience of the impact of the COVID-19 pandemic on anxiety symptoms, social and vocational functioning was measured utilising the same Likert scales at both time points. Anxiety symptoms were additionally measured using subjective (Beck Anxiety Inventory) and objective (Hamilton Anxiety Rating Scale (HARS)) psychometric instruments. Paired t-tests or Wilcoxon ranked tests compared parametric or non-parametric data over time. Free-text responses pertaining to participants' perspectives on the impact of COVID-19 were grouped into themes. RESULTS: A minor increase in anxiety symptoms was demonstrated utilising the HARS (1.9 points, z = 3.017, p = 0.003), with a minimal increase in depressive symptoms noted using Likert ratings (0.8 points, z = 2.119, p = 0.034). Five themes were identified with the most prevalent being (i) positivity regarding vaccination, (ii) social isolation from family members and (iii) looking forward to post-COVID-19 'normality'. However, negative views pertaining to the psychosocial impact of COVID-19 and vaccination were additionally reported. CONCLUSIONS: No significant overall clinical change in symptomatology or functioning over time was noted.The study demonstrated that positive views regarding vaccination and optimism for the future were evident for some participants.

Efficacy and safety of scopolamine compared to placebo in individuals with bipolar disorder who are experiencing a depressive episode (SCOPE-BD): study protocol for a randomised double-blind placebo-controlled trial.

BACKGROUND: Current treatment options for the management of depressive episodes in bipolar disorder are often sub-optimal, with some treatments either noted to be only partially effective or to require long durations of treatment prior to a therapeutic response. Therefore, pharmaco-therapeutic options that reduce depressive symptoms in a more rapid manner might provide a viable therapeutic option for some people. Intravenous (IV) scopolamine, a pan muscarinic antagonist, has been demonstrated in a number of studies to confer a rapid antidepressant effect, albeit no study to date has exclusively evaluated its potential therapeutic effect in a cohort consisting solely of individuals with bipolar disorder. METHODS: Individuals with bipolar disorder who are currently experiencing a depressive episode of at least moderate severity will be included in this study. Eligible participants will undergo a screening and placebo-run in visit and will be randomised at visit 3 to the treatment or placebo group. Participants will receive the three blinded infusions over the course of 2 weeks, with two subsequent follow-up visits, 1 and 3 weeks after the last infusion visit. The total duration of the study will be approximately 6 weeks. Patients will continue their regular treatment regime in addition to study medication. Objective and subjective mood questionnaires, cognitive assessments and other psychometric instruments will be administered and recorded. DISCUSSION: To our knowledge, this is the first study to investigate the antidepressant effects of IV scopolamine in an exclusively bipolar disorder cohort. Trial findings will contribute to the evidence base regarding the cholinergic hypothesis of mood disorders and specifically might result in an additional safe therapeutic option for the management of depressive episodes in bipolar disorder. TRIAL REGISTRATION: ClinicalTrials.gov NCT04211961 . December 26, 2019. EudraCT Number 2017-003112-39.

SafePsych: improving patient safety by delivering high-impact simulation training on rare and complex scenarios in psychiatry.

INTRODUCTION: Despite an evidence base demonstrating simulation to be an effective medical education tool, it is not commonly used in postgraduate psychiatry training as it is in other medical specialties. OBJECTIVE: This paper outlines the development and effectiveness of a hybrid-virtual simulation-based workshop designed to improve patient care by improving clinical skills of non-consultant hospital doctors (NCHDs) in detecting and managing rare and complex psychiatric emergencies. METHODS: Three clinical vignettes based on near-miss psychiatric cases were developed by a multidisciplinary team of physicians and nurses in psychiatry and experts in simulation-based medical education. The workshop, 'SafePsych' was delivered in a simulation laboratory while and broadcast via Zoom video-conferencing platform to observers. Debriefing followed each clinical scenario. Participants completed preworkshop and postworkshop questionnaires to evaluate clinical knowledge. RESULTS: The workshop was attended by consultants (n=12) and NCHDs in psychiatry and emergency medicine (n=19), and psychiatric nurses (n=5). In the psychiatry NCHD group, test scores significantly improved following the workshop (p<0.001). There were significant improvements in the test scores with a mean difference of 2.56 (SD 1.58, p<0.001). Feedback from participants and observers was positive, with constructive appraisals to improve the virtual element of the workshop. CONCLUSION: Simulation-based training is effective in teaching high risk, rare complex psychiatric cases to psychiatry NCHDs. Further exploration of the learning needs of nursing staff is required. Future workshop delivery is feasible in the COVID-19 environment and beyond, using a virtual element to meet social distancing requirements while enhancing the reach of the training.

Qualitative Analysis of Interactions on an Online Discussion Forum for Young People with Experience of Romantic Relationship Breakup.

The aim of the current study was to use qualitative analysis to examine the ways in which young people with experience of romantic relationship breakup interact with each other on an Internet-mediated discussion forum and to ascertain the function of the interactions. Participants were 31 registered forum users and 10 forum moderators. Findings were based on content analysis of 238 messages posted across 28 distinct discussion threads over 12 consecutive months. Nine different types of interaction were identified. In each case the function of the interaction was identified (e.g., to relay personal experiences or solicit opinions of others) and illustrated using quotations from the data set. Online discussion forums that are facilitated by trained moderators offer a safe space for young people to disclose personal information and express their emotions in respect of romantic relationship breakup. Online interactions are rich in empathy and peer support is evident among visitors to such forums.