Hunting for Pearls: A Qualitative Analysis of the Reflections of Students Creating Psychiatric Podcasts.

Purpose: This paper aims to explore medical student experiences of creating a peer-to-peer psychiatry educational podcast. Methods: During psychiatry placement, ten year-4 University of Bristol medical students created peer-educational multi-episode podcasts on psychiatric topics. Following completion, they submitted reflective essays on their experiences. Qualitative thematic analysis of these essays was completed by two independent authors. Following data familiarisation, authors independently generated codes that were collated into relevant themes. Upon reaching thematic saturation, findings were collated, and member checking was carried out to confirm the validity of findings. Results: Themes included effective preparation, choosing content, podcast production, enhancing learning, the weight of responsibility and creating educational support networks. All students found podcast creation to be beneficial for personal learning. Conclusion: Exploration of students' experiences creating podcasts can support clearer guidance for medical podcast production, providing opportunities for educators to optimise podcast creation efficiency and educational effectiveness.

The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application.

BACKGROUND: Semi-structured interview scales for psychosis are the gold standard approach to assessing psychotic and other symptoms. However, such assessments have limitations such as recall bias, averaging, insensitivity to change and variable interrater reliability. Ambulant, real-time self-report assessment devices may hold advantages over interview measures, but it needs to be shown that the data thus collected are valid, and the collection method is acceptable, feasible and safe. We report on a monitoring system for the assessment of psychosis using smartphone technology. The primary aims were to: i) assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis, and ii) examine compliance to the procedure in individuals with psychosis of varying severity. METHODS: A total of 44 participants (acute or remitted DSM-4 schizophrenia and related disorders, and prodromal) completed 14 branching self-report items concerning key psychotic symptoms on a touch-screen mobile phone when prompted by an alarm at six pseudo-random times, each day, for one week. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data. RESULTS: Compliance as defined by completion of at least 33% of all possible data-points over seven days was 82%. In the 36 compliant participants, 5 items (delusions, hallucinations, suspiciousness, anxiety, hopelessness) showed moderate to strong (rho 0.6-0.8) associations with corresponding items from interview rating scales. Four items showed no significant correlation with rating scales: each was an item based on observable behaviour. Ambulant ratings showed excellent test-retest reliability and sensitivity to change. CONCLUSIONS: Ambulatory monitoring of symptoms several times daily using smartphone software applications represents a feasible and valid way of assessing psychotic phenomena for research and clinical management purposes. Further evaluation required over longer assessment periods, in clinical trials and service settings.

Neuropsychiatric sequelae in an efavirenz treated patient with hepatitis B.

We report the case of a 34-year-old man of African origin, positive for both HIV and hepatitis B virus, who developed symptoms of mania and psychosis while being treated with efavirenz (a non-nucleoside reverse transcriptase inhibitor used in HIV therapy) that required inpatient psychiatric admission and treatment with antipsychotic medication. Our case illustrates multiple predisposing and precipitating factors occurring simultaneously that have been previously implicated individually in the development of neuropsychiatric complications with efavirenz (and other HIV treatments in general). We suggest that patient's commenced on antiretroviral medication should have a screening process for pre-existing mental and medical health problems as well as psychosocial risk factors that might put a patient at risk. In addition with advances in pharmacogenomics we advocate future cytochrome P450 gene variant testing coupled with routine efavirenz plasma concentration monitoring to help ensure maximum treatment benefit and minimal risk of side effects.

A randomised controlled trial to determine the effectiveness of an early psychological intervention with children involved in road traffic accidents.

OBJECTIVE: To determine whether an early intervention using a psychological debriefing format is effective in preventing psychological distress in child road traffic accident survivors. DESIGN: Randomised controlled trial. SETTING: Accident and Emergency Department, Royal United Hospital, Bath. SUBJECTS: 158 children aged 7-18. Follow-up assessment completed eight months post accident with 132 (70/82 of the experimental group and 62/76 in the control group). MAIN OUTCOME MEASURES: Self-completed measures of psychological distress; fulfilment of diagnostic criteria for post-traumatic stress disorder. RESULTS: Children in both groups demonstrated considerable improvements at follow-up. The early intervention did not result in any additional significant gains. CONCLUSIONS: Although children in this study made significant improvements it is unclear whether these are better or worse than natural recovery rates. The specific intervention did not result in additional gains although the structured assessment provided for both groups may have been helpful in reducing subsequent pathology.

Young people's experience of emergency medical services as road traffic accident victims: a pilot qualitative study.

A visit to the Accident and Emergency (A&E) department following an accident is often a young person's first experience of hospital. A&E is a pressured environment which can be frightening and stressful for young people. This study reports the views of young people who have had contact with emergency medical services following a road traffic accident (RTA). Negative experiences were volunteered more than positive experiences. Concerns were reported around being physically restricted, receiving inadequate information, feeling that they were not understood, experiencing physical discomforts and feeling lonely. This article highlights the need to provide adequately for the younger A&E patient by supplying information, communicating appropriately and offering an environment that is more appropriate for young people.

Posttraumatic growth in child survivors of a road traffic accident.

Although the negative consequences of trauma have been well researched and described, posttraumatic growth has only recently come to the attention of researchers. This paper considers whether children (aged 7-18 years) who have been involved in a road traffic accident can experience posttraumatic growth outcomes. From 158 children who took part in an interview, qualitative analysis of interview notes found that 67 (42%) reported some aspect of posttraumatic growth, most notably in terms of their philosophy of life. Of these, 25 (37%) were also assessed as experiencing posttraumatic stress disorder.

Posttraumatic stress disorder following road traffic accidents - a second prospective study.

OBJECTIVE: The aim of this prospective study was to determine the psychological effects of everyday road traffic accidents (RTAs). METHODS: A community follow-up study was made of children (75 boys and 83 girls aged 7-18)-attending an Accident and Emergency Department after being involved in an RTA. Diagnostic clinical interview and self-completed psychometric assessments were performed. RESULTS: Four weeks post-accident diagnostic interviews revealed that 46 (29.1 %) children fulfilled the diagnostic criteria for posttraumatic stress disorder (PTSD). Screening questionnaires identified 20.3% with significant levels of anxiety and 17.7% with scores above threshold levels for possible clinical depression. Type of accident, nature and severity of injury and age were not related to the development of PTSD. Gender was significant, with girls being more likely than boys to develop PTSD. CONCLUSION: Significant psychological distress following RTAs is common. The need to raise awareness of the possible psychological sequelae of everyday RTAs is highlighted.

Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of hospital episode statistics.

BACKGROUND: Rates of deliberate self-harm (DSH) were increasing in the United Kingdom during the 1980s and early 1990s, particularly among young adult males. Self-poisoning with paracetamol was the most common means, with overdoses of anti-depressants becoming more frequent. Changes to paracetamol pack size regulations in 1997 have been followed by a reduction in overdoses, and there has been more prescription of anti-depressants less likely to necessitate hospitalization if overdosed. Improved liaison psychiatry services and increased levels of employment are among the factors that would suggest an impact on hospital admissions for self-harm. This study analysed DSH admissions to hospitals in England from 1995/96 to 1999/2000 to examine changes. METHODS: A retrospective analysis of the Hospital Episode Statistics database was carried out. RESULTS: Hospital admissions for DSH rose to 153 per 100000 in 1997/98, then declined to 143 per 100000 in 1999/2000. Paracetamol overdoses decreased from 77 to 67 per 100000. The use of anti-depressants or tranquillizers grew from 56 to 75 per 100000 during the 5 years. Self-injury, narcotics overdoses and the use of alcohol continued to increase over time. CONCLUSIONS: Yearly increases in admissions for DSH to hospitals in England reversed in 1998/99 and stabilized in 1999/ 2000. These changes were most noticeable for the 16-24 years age group. The use of paracetamol decreased, whereas other means of self-harm increased. Regional differences and the relationship between rates of DSH in the community and hospital should be explored further.