Cognitive stimulation therapy (CST) is a psychosocial treatment for people with dementia. It is an evidence-based treatment which shows improvement in cognition, well-being and quality of life of people living with dementia. CST is recognised as one of the interventions which is cost-effective.

The National Institute of Health and Care Excellence (NICE) guideline recommends that people with mild to moderate dementia should be given opportunities to take part in CST. The CST sessions done in North Norfolk are weekly sessions which span 90 minutes. A group of between 8–10 people attend a 14-week CST treatment course.

The aim of this study is to evaluate the effectiveness of the CST on cognition and social independence of patients with dementia in North Norfolk.

Patients diagnosed with mild to moderate dementia at the memory service were referred for CST sessions. A trained professional assessed the patients to determine their eligibility for CST. The assessment included: assessing motivation to join a group therapy, administration of the short-version of the Addenbrooke Cognitive Examination questionnaire (MINI-ACE) to assess cognitive functions and the administration of Engagement and Independence in Dementia Questionnaire (EIDQ) which measures the social independence of the patients. A higher score on both questionnaires indicates better cognitive function and social independence, respectively.

The CST sessions spanned from February 2023 to May 2023. The patients were re-assessed after the 14-week sessions of CST for their MINI-ACE and EIDQ scores. A qualitative questionnaire was administered for feedback about the sessions.

Data were obtained from patients' clinical record following approval from the research and service evaluation team of the Trust.

Nine patients completed the 14-week CST sessions. The mean age of the patients was 82.9 ± 4.8. 66.7% were male and 33.3% were female. 77.8% were on memory medication and 22.2% were not on memory medication. 44.4%, 33.3%, 11.1% and 11.1% were diagnosed with dementia in Alzheimer's Disease; Mixed Alzheimer's-Vascular Dementia, Lewy Body Dementia and Frontotemporal Dementia, respectively.

The same proportion of patients (44.5%) had both increased and decreased MINI-ACE score after CST while 11% had no changes in MINI-ACE score. Majority (66.7%) had increased EIDQ score after CST, 22.2% had decreased EIDQ score and 11.1% had no changes.

The CST sessions done in North Norfolk showed more positive effect on social independence than cognition in people with dementia.

Maternal mental health is an integral component of services that should be rendered to pregnant women in addition to their physical health during their antenatal care. Mental health conditions are screened for during these visits. There is a high prevalence of anxiety disorders among this group of women. A common questionnaire used to screen for anxiety is the 7-item generalized anxiety disorder (GAD-7). However, this instrument has not been validated among pregnant women in Nigeria. We conducted research among pregnant women in Southwest Nigeria to demonstrate the psychometric properties of GAD-7 using the anxiety modules of the Mini International Neuropsychiatric Interview (MINI) as a gold standard.

We administered both GAD-7 and the anxiety module of MINI among 203 pregnant women who attended 4 randomly selected primary health centres in Southwest Nigeria. The data collected from these questionnaires were analysed using the Statistical Package for Social Sciences (SPSS).

The reliability of GAD-7 was assessed with Cronbach's alpha to estimate its internal consistency. The validity of GAD-7 was examined with an assessment of its concurrent validity, sensitivity, and specificity analysis and a receiver operator characteristic curve.

Using Pearson correlations, we evaluated the concurrent validity of GAD-7 and the anxiety modules of the M.I.N.I. The sensitivity, specificity, positive predictive, and negative predictive values of GAD-7 were determined with the MINI as a gold standard. The predictive accuracy was further determined from receiver operating curve analysis using the area under the curve as a standard measure.

The internal consistency value measured by Cronbach's alpha for GAD-7 was 0.709. GAD-7 correlated minimally with the anxiety modules of MINI with a coefficient score (r) of 0.393 at a p-value of 0.01. GAD-7 has a low sensitivity & negative predictive value of 14.1% and 57.8% respectively and a high specificity & positive predictive value of 97.3% and 81.2% respectively. The area under the curve using receiver operating curve analysis was above the chance line of 0.5 with a value of 0.0557 at p < 0.05.

GAD-7 is a reliable and moderately valid instrument to screen anxiety among pregnant women in Southwest Nigeria.

Health comorbidities contribute significantly to the development and maintenance of illness in patients with Functional Neurological Disorder (FND). As part of a service evaluation project, we investigated the physical and mental health comorbidities of people referred to a community neuropsychiatry service in East Kent, in one-year periods preceding and following the March 2020 lockdown due to COVID-19.

We included all people accepted to the service between 23rd March 2019 and 23rd March 2021, where the reason for referral was Functional Neurological Disorder (FND) or Non-Epileptic Attack Disorder (NEAD). Referrals to the service for other reasons were excluded, as were declined referrals. Routinely collected data sources were reviewed and data stored in anonymized fashion. Data were analysed using Statistical Package for Social Sciences (SPSS).

Total number of referrals for FND in the 2-year period was 260, with 161 referrals for NEAD and 99 for other FND.

In the pre-lockdown period, 163 patients were referred due to FND (101 with NEAD, 62 for other FND). There were fewer FND referrals in the post-lockdown period: 60 referrals for NEAD and 37 for other FND. The majority were female (74% pre-lockdown, 81% post-lockdown). Where ethnicity was recorded, White British was the most common (94% pre-lockdown, 90% post-lockdown), with a small number of people from other ethnic groups (3.5% White Other, 1.4% BAME, 1.4% Mixed pre-lockdown; 5.4% White Other, 3.2% BAME and 1.1% Mixed post-lockdown). Ethnicity was not specified in 21 cases (13%).

Of the pre-lockdown group, 15 patients had prior contact with Child and Adolescent Mental Health Services (9%), with 7 patients (7%) in the post-lockdown group. Many patients had previous contact with mental health services (47% pre-lockdown, 53% post-lockdown). The majority of patients had at least one physical illness (69% pre-lockdown, 73% post-lockdown). Most had 1–3 physical comorbidities but 9% (pre-lockdown, 7% post-lockdown) had more than 4. Fibromyalgia (14% pre-lockdown, 12% post-lockdown), chronic pain (23% pre-lockdown, 21% post-lockdown), and epilepsy (11%, 9%) were common. Over 90% had psychiatric illness in both periods. Most patients had 1–3 psychiatric illnesses; a few had more than 4 (6.1% pre-lockdown, 1.4% post-lockdown). Depressive disorder was the most common comorbidity in both groups (41% pre-lockdown, 44% post-lockdown), followed by anxiety (35% pre-lockdown, 36% post-lockdown). PTSD was present in 8% pre-lockdown and 8.2% post-lockdown.

Physical and psychiatric comorbidities are common in people with FND; multidisciplinary working and liaison between services is crucial for care of these patients.

Neuropsychiatry Service in East Kent typically receives referrals for patients with brain injury, progressive neurological conditions, epilepsy specific neuropsychiatric conditions, rare forms of dementia, and functional neurological conditions. COVID-19 pandemic disrupted routine functioning of the service requiring multiple service innovations including introduction of remote access assessments, skills development clinics, and video-conferencing based psychoeducation groups. We conducted a service evaluation with governance approval to understand the impact of COVID-19 work model changes on referral sources, patient attendance, discharge destinations and the mental health professionals’ involvement in the management of the patients referred to the service.

We applied to Service Evaluation and Audit Group of Kent and Medway NHS Partnership Trust for permission to collect service data using routinely collected clinical and business administration information. We used an approved data collection form for anonymized data collection. We analysed data for new patient assessments conducted over one-year prior to COVID-19 lockdown announced on 23rd March 2020 and compared it with one-year post-COVID lockdown period ending on 22 March 2021. We used Statistical Package for Social Sciences (SPSS) to carry out descriptive and statistical analysis of the data from two service evaluation period.

The total number of new patient assessments conducted during the two designated service evaluation periods was 365. 233 new patient assessments (64%) were conducted during the one-year pre-COVID-19 lockdown and 132 (36%) new patient assessments were conducted during the one-year post-COVID-19 lockdown.

Neurology teams in the local area were the main source of referrals during the two study periods, referring 59% and 51% of total referrals during the two evaluation periods respectively. Other referral sources included local memory service, inpatient psychiatric units, community mental health teams, neuropsychology, neurorehabilitation, palliative care and acute medicine. The primary management model was multidisciplinary. 49% of assessment contacts were made by specialist nursing during the first evaluation period. 48% of assessment contacts were made by the medical staff during the post-lockdown period. 13.3% of patients did not attend their appointments during the first period, dropping to 9.8% in the Post-Lockdown period.

Most patients who completed treatment were discharged to GP care (89% pre-COVID-19 and 94% post-lockdown). 12% patients from Pre-Lockdown period were still receiving care at the end of one year and 35% were still receiving care in at the end of post-lockdown period.

The service evaluation identifies systemic differences in service use characteristics during Pre-lockdown and Post-lockdown periods.