Sleep deprivation as a treatment for major depressive episodes: A systematic review and meta-analysis.

Sleep deprivation, alone or in combination with pharmacological treatment and as part of a chronotherapy package, is of potential use for people with major depressive episodes, however the evidence base is still conflicting. The aim of this systematic review and meta-analysis is to assess the clinical effects of sleep deprivation in comparison to any other intervention for the acute and long-term treatment of mood disorders. We searched electronic databases and trial registries (last update: 16th October 2021) for published and unpublished randomised controlled trials recruiting participants with a major depressive episode in unipolar or bipolar affective disorder. The clinical outcomes of interest were the reduction in depressive symptoms at different timepoints and the number of participants experiencing at least one side effect. Overall, 29 trials (1246 participants) were included. We did not find any difference in change in symptoms or all-cause discontinuation between interventions including SD compared to a control of the same intervention except without SD. In the included studies there were no available data for adverse events. Using the most methodologically rigorous approach, we did not find evidence that the addition of sleep deprivation to treatment packages leads to enhanced depressive outcomes.

Impact of COVID-19 on telepsychiatry at the service and individual patient level across two UK NHS mental health Trusts.

BACKGROUND: The effects of COVID-19 on the shift to remote consultations remain to be properly investigated. OBJECTIVE: To quantify the extent, nature and clinical impact of the use of telepsychiatry during the COVID-19 pandemic and compare it with the data in the same period of the 2 years before the outbreak. METHODS: We used deidentified electronic health records routinely collected from two UK mental health Foundation Trusts (Oxford Health (OHFT) and Southern Health (SHFT)) between January and September in 2018, 2019 and 2020. We considered three outcomes: (1) service activity, (2) in-person versus remote modalities of consultation and (3) clinical outcomes using Health of the Nation Outcome Scales (HoNOS) data. HoNOS data were collected from two cohorts of patients (cohort 1: patients with ≥1 HoNOS assessment each year in 2018, 2019 and 2020; cohort 2: patients with ≥1 HoNOS assessment each year in 2019 and 2020), and analysed in clusters using superclasses (namely, psychotic, non-psychotic and organic), which are used to assess overall healthcare complexity in the National Health Service. All statistical analyses were done in Python. FINDINGS: Mental health service activity in 2020 increased in all scheduled community appointments (by 15.4% and 5.6% in OHFT and SHFT, respectively). Remote consultations registered a 3.5-fold to 6-fold increase from February to June 2020 (from 4685 to a peak of 26 245 appointments in OHFT and from 7117 to 24 987 appointments in SHFT), with post-lockdown monthly averages of 23 030 and 22 977 remote appointments/month in OHFT and SHFT, respectively. Video consultations comprised up to one-third of total telepsychiatric services per month from April to September 2020. For patients with dementia, non-attendance rates at in-person appointments were higher than remote appointments (17.2% vs 3.9%). The overall HoNOS cluster value increased only in the organic superclass (clusters 18-21, n=174; p<0.001) from 2019 to 2020, suggesting a specific impact of the COVID-19 pandemic on this population of patients. CONCLUSIONS AND CLINICAL IMPLICATIONS: The rapid shift to remote service delivery has not reached some groups of patients who may require more tailored management with telepsychiatry.

A collaborative strategy to improve geriatric medical education.

INTRODUCTION: Age-related demographic change is not being matched by a growth in relevant undergraduate medical education, in particular communication skills pertinent to elderly patients. To address this, a workshop for medical students focusing on important communication skills techniques for interacting with patients with dementia was designed by clinicians from the Geriatric, General Practice and Psychiatry departments at the University of Oxford. METHODS: One hundred and forty-four first-year clinical students (Year 4 of the 6-year course; Year 2 of the 4-year graduate-entry course) attended the teaching. One hundred and twenty-nine students returned feedback forms with 104 forms matched for individual performance before and after the session. Feedback forms assessed student-perceived confidence in communicating with patients with dementia before and after the session using a 4-point Likert scale with corresponding numerical value (low (1), medium (2), high (3), very high (4)). RESULTS: Using the Wilcoxon Signed-Rank Test on the 104 matched forms, student-perceived confidence was higher post-teaching intervention (median = 2.75) than pre-intervention (median = 1.50). This difference was statistically significant with large effect size, Z = -8.47, P < 0.001, r = -0.59. Free-text comments focused on non-verbal communication skills teaching, suggesting that these sessions were most beneficial for topics hardest to teach in lecture-based approaches. CONCLUSION: The teaching aimed to promote patient-centred care and multidisciplinary collaborative practice, encourage student self-reflection and peer-assisted education and provide insight into the needs of patients with dementia. Student feedback indicated that these objectives had been met. This easily replicable teaching method provides a simple means of improving communication skills.

The effect of ethnicity and gender on first-contact rates for schizophrenia-like psychosis in Bangladeshi, Black and White elders in Tower Hamlets, London.

BACKGROUND: A recent study of very-late onset schizophrenia-like psychosis (SLP) in South London showed an increase in first contact rates amongst African- and Caribbean-born elders compared to British-born ones. This study investigates incident first contact rates in an area of East London with a high Bangladeshi population, to investigate if Bangladeshi-born elders also have an increased referral rate for SLP. METHOD: Retrospective case note review of first contacts to the old age psychiatry service from 1997 to 2002 identifying cases of schizophrenia-like psychosis. In addition, a one-year review of first contacts for all diagnostic categories was completed. Gender, ethnicity and place of birth were established from the case notes. RESULTS: Among the African- and Caribbean-born, but not the Bangladeshi-born, the odds ratio (OR) of being referred with SLP was significantly higher than for the British-born population. We observed a loss of the reported effect of female gender. For Whites the odds ratio for female gender and psychosis was 2.5 (1.0-6.1) and for non-Whites 0.8 (0.3-2.7) which was a trend away from the expected male to female ratio. In the one-year review there was a higher rate of referrals for organic disease in Bangladeshi men compared to Bangladeshi women and British-born men and women. CONCLUSIONS: Bangladeshi elderly migrants do not have an increased rate of SLP compared to indigenous elders. The usual female preponderance of SLP is not apparent in this elderly migrant population. Old age psychiatry services in the UK should take into account the increasing needs of Bangladeshi elders with dementia.