12 results
Gogledd Cymru-Peer Supervision in Psychotherapy (GC-PSP): What Are Lessons Learned After Two Years?
- Jiann Lin Loo, Manjula Simiyon, Rajvinder Singh Sambhi
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S29-S30
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Core trainees in psychiatry (CT) must attain competencies in at least two psychotherapy modalities before they are allowed to sit for the final Royal College of Psychiatrists’ membership exam. The common training approaches in the United Kingdom include regional training workshops, weekly Balint groups, and access to individual supervision. Some CTs express their wish to have extra opportunities to practice psychotherapeutic skills and discuss cases in order to enrich their experience in learning psychotherapy. Therefore, the peer-led GC-PSP, i.e. Gogledd-Cymru (North Wales) Peer Supervision in Psychotherapy is conceptualised as a quality improvement project (QIP) for North Wales CTs. This article aims to illustrate the lessons learned after two years of GC-PSP.
MethodsA baseline survey was done to identify trainees’ ideas, concerns, and expectations in psychotherapy training and weekly one-hour supervision sessions were set up in May 2021. Sessions were facilitated by a speciality trainee (ST) in psychiatry with experience in psychotherapy. The agenda was determined on the day based on the specific issue or expectation brought up by trainees which could include: clarification of psychotherapeutic concepts and knowledge learned elsewhere, skill training through role-playing, case formulation of clinical encounters, discussions on suitable intervention, and any topics that were relevant to psychotherapy or combination. Subsequent written and verbal feedback was gathered.
ResultsA total of 48 sessions had been conducted in two years, with 37.5% covering knowledge teaching, 45.83% skills training, and 39.58% case-based discussions. The top five modalities requested by CTs included: cognitive behavioural therapy (32.35%), psychodynamic therapy (20.59%) acceptance and commitment therapy (17.65%), motivational interview (11.76%), and behavioural activation (8.82%). The overall attendance had been inconsistent, ranging from no attendees and the highest of eight attendees comprising medical students, foundation year trainees, core psychiatry trainees, general practitioner specialist trainees, and specialist registrars.
ConclusionAlthough inconsistent attendance results in the repetition of discussions and topics, all trainees feel the extra sessions support their learning in psychotherapy in a safe space as they feel the small group discussion allows more active participation and they are able to learn from others on top of their individual supervision (positive Kirkpatrick level 1 reaction). All trainees wish to have this initiative continued and prefer a semi-structured rather than totally flexible agenda so that they can plan for their attendance, which can be a consideration for future implementation.
Postgraduate Teaching Programme in Psychiatry in North Wales- a Regional Quality Improvement Project 2022-2023
- Asha Dhandapani, Sathyan Soundararajan, Catherine Baker, Rajvinder Sambhi
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S86-S87
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
We aimed to arrange the local Postgraduate teaching in psychiatry as per the Deanery requirement/ HEIW requirement. We aim to achieve a better target with regard to local teaching as noted from the previous year's GMC trainee survey
MethodsThe project started in 2019. 3 sets of audits and PDSA's were done- one each year, before the final PDSA. During these 3 audits, only non-consultants were participants.
During the 4th PDSA, in 2022-2023, a purposive sample was selected to provide the best information possible for the audit. It included Consultant Psychiatrists from all three sites in North Wales, Trainees( Junior/ Senior), SHO, speciality doctors, FY2, GP trainees and Clinical fellows. The criteria for participation were that the doctors should be working in Psychiatry and should have attended the local postgraduate programme. Access to the internet and appropriate device was mandatory as an add-on availability.
An online questionnaire was emailed to the participants. There were only 3 questions for the Consultants and 5 for the non Consultants’ group. 2 weeks window was offered to fill out the forms.
ResultsThe 3 audits done initially revealed that consistent formal teaching was not provided. The candidates also found the current programme not fulfilling the criteria laid by the deanery and that their educational needs were neglected. The summary of the old audits suggested that the teaching had worsened eventually.
The final PDSA was done in 2022-2023. The overall time to fill out the form was 1.43 minutes. An equal number of Consultants and Non-consultants filled out the form. 31 Consultants rated the new programme as 4.23 for 5. The 31 non-consultants rated the programme 3.68 out of 4 and 95% identified that the new postgraduate programme covered the core trainees' requirements as per the MRCPsych Handbook from the Deanery.
ConclusionPrioritisation of the most important facilitators and identification of ‘easy wins’ are important steps in this process.
The purpose of this study was to develop a national expert group consensus amongst a range of relevant stakeholders; senior doctors, residents, patients, allied healthcare professionals and healthcare managers allowing us to;
1. identify important barriers and facilitators of learning in clinical environments and
2. indicate priority areas for improvement. Our overarching objective was to provide information to guide policymakers and those tasked with the delivery of graduate medical education in tackling the provision of high-quality clinical learning environments in challenging time
Successful Clozapine Rechallenge With Add on Filgrastim in a Case of Treatment Resistant Schizophrenia With Clozapine Associated Neutropenia: A Case Report
- Nikhil Gauri Shankar, Rajvinder Singh Sambhi, Ibrahim Alnassar
-
- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S122
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
Clozapine is the treatment of choice in treatment resistant schizophrenia (TRS). Neutropenia is a potential life threating adverse effect associated with Clozapine treatment and one of the common reasons leading to discontinuation of Clozapine treatment. Clozapine associated neutropenia can be managed with Lithium or Granulocyte Colony Stimulating factor (G-CSF).Clozapine rechallenge in patients may often seem necessary and should follow a careful and balanced risk-benefit analysis. We present a case of a patient with TRS on Clozapine who developed neutropenia which responded to Filgrastim add on therapy and was successfully continued with Clozapine treatment.
MethodsA 29 year old female with a diagnosis of Schizophrenia since age 22 years had poor response to 4 different antipsychotics and 2 episodes of Neutropenia on separate occasions with Clozapine treatment. An inpatient Clozapine rechallenge was trialled due to poor response to the ongoing antipsychotic treatment which resulted in a decrease in the absolute neutrophil count to 1.7 *109/Litre.
An MDT decision was taken to continue Clozapine treatment with add on Filgrastim due to the severe psychopathology and poor quality of life. As per the advice from the haematologist Filgrastim injections at a dose of 30 million International Units were commenced on pro re nata (prn) basis whenever ANC dropped below 2.0*109/Litre. This strategy was successful and the patient did not develop agranulocytosis. Her psychotic symptoms also improved significantly and the patient was discharged to the community rehabilitation team.
ResultsClozapine is often the last resort in treating refractory psychotic symptoms and this option may get limited due to adverse effects like Neutropenia and agranulocytosis. Add on therapy with G-CSF has been used in Clozapine rechallenge with various success rate and most of the supporting data are derived from case reports and case series. It is worth noting that regular and prophylactic G-CSF in absence of low neutrophil count is avoided which could mask a developing Clozapine induced Neutropenia and result in a steep drop in neutrophils.
ConclusionAdd on therapy with Filgrastim is a viable option when considering Clozapine rechallenge with previous history of Clozapine induced Neutropenia. It is important that a haematologist is consulted and the patient is monitored closely throughout the treatment.
Admission Clerking- Inpatient Adult Psychiatric Unit - a Quality Improvement Project
- Asha Dhandapani, Sathyan Soundara Rajan, Alberto Salmoiraghi, Rajvinder Sambhi, Catherine Baker, Joanne Kendrick, Sherrie Stewart
-
- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S91
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
To improve the clerking proforma and physical healthcare for General Adult Psychiatric inpatients in Heddfan Psychiatric Unit, Wrexham by 100% within 18 months period with a long term goal of continuous improvement.
MethodsWe started the project with a baseline audit which showed the incompleteness of vital data when clerking a patient in adult psychiatric inpatient unit. This was compared with various standards from Core competencies for a trainee in Psychiatry, NICE guidelines and Local trust policy from our own trust BCUHB for physical health monitoring and Department of Health Guideline for VTE.
With the findings obtained, we went ahead to create a proforma encompassing all the details.
The use of various Quality improvement tools such as Fishbone diagram, Drivers diagram and PDSA cycles gave as overwhelming results
ResultsThe baseline audit, repeat audits and PDSA cycles have shown tremendous and overwhelming results in terms of completion of the proforma. This has resulted in mandatory details being inputted sufficiently in the patient's notes.
Many of the important details such as medication details, allergy status, legal and forensic status, mental state examination, risk assessment, VTE assessment, investigation details and documentation have shown to have improved during this 1 year
ConclusionThis QIP has been patient centred as this is the main goal. Following the PDSA cycle, we have identified that it has been efficient and effective. It has been safe and also reduced the chances of patient neglect. The structure of the proforma used does not discriminate or show any inequalities and is timesaving too.
The SWOT analysis has been completed, which has shown that the teamwork and support from the Consultants and other stakeholders have been a major strength. There are a few weaknesses such as unavailability of ECG machine, missing documentation of investigations despite completing them but however with timely education to the junior doctors, we are hoping for improvement further. This QIP has opened up doors for various opportunities, such as including nursing and pharmacy admission forms into this proforma. Though there are few threats in achieving 100% success, we are hoping for the best
Manualising the induction of higher trainees in psychiatry for North Wales: The CiSGC Guide (“Croeso i Seiciatreg Gogledd Cymru”)
- Jawad Raja, Jiann Lin Loo, Rajvinder Sambhi, Somashekara Shivashankar
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S214-S215
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
There is a significant period of adjustment for new higher trainees in psychiatry given the presence of inter-trust differences in the National Health Services (NHS). It may take some time for a trainee to become familiar with the new administrative system and workflow of the new environment, which may be even longer for an international medical graduate (IMG). Although there is an existing induction system, having a written structured manual will assist the trainees to get through this process more easily. Hence, this Quality Improvement Project (QIP) outlined the creation of an induction manual that serves as a starter pack to facilitate the settling-in process of new North Wales higher trainees in psychiatry, i.e. the “Croeso i Seiciatreg Gogledd Cymru” (CiSGC) guide (means Welcome to North Wales Psychiatry in Welsh).
MethodThe induction manual was initially drafted by the authors based on the available printed policies and information online. Further input and from different stakeholders were obtained to triangulate and enrich the manual. Specific links and further references were included in the manual for the reference of prospective manual users. Authors’ contact details were included for any further clarification, suggestions or input.
ResultThe manual consisted of four sections: A) General Process before, during and after Reporting Duty, B) Trainees’ Duty, 3) Speciality-specific Guidance, and 4) Health Board-related Information. The General Process section covered the visa-related information, post-acceptance paperwork process, access to email and hospital informative system, medical practice-related issues (including section 12(2) approval and medical indemnity). The Trainees’ Duty section briefed on time-tabling and clinical duty. The Specialty-specific Guide provided important information related to training. Lastly, the section of Health Board-related Information highlighted the administrative structure of the NHS Health Board, important contact numbers, link to information. Specialty specific sections were created for general adult psychiatry and old age psychiatry as there is no other higher training of psychiatry in North Wales at the moment. Further sections in the pipeline include substance misuse and liaison psychiatry.
ConclusionThis induction manual is neither prescriptive nor exhaustive. It serves as a generic reference to facilitate new trainees in their adjustment process. Further review and revision will be conducted before every induction process to ensure the information is up-to-date and incorporating new input from the trainees.
Are the staff in Heddfan Psychiatric Unit, Wrexham Maelor Hospital, are adhering to the personal protective equipment (PPE) guidance as per Public Health Education, England? a QIP
- Asha Dhandapani, Sathyan Soundararajan, Rajvinder Sambhi, Catherine Baker
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S184
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
The aim of this audit is to assess whether healthcare staff are correctly donning and doffing PPE when entering and leaving the wards (changed to donning and doffing PPE when within 2 metres vicinity of a patient).
MethodConsultants/ Junior doctors/ Ward managers/ Staff nurses/ student nurses/ Health care support workers/ Occupational therapist/ Psychologists/ Student nurses/ Housekeeping staff, were all included in this Audit. None of the staff was aware of this Audit and this was an entirely random observation. We used a standard proforma in order to audit. Followed by the Audit, we trained the staff in the unit and then re-audited.
Result98% of them wore mask whilst in the ward and 94% of them washed their hands after doffing. 36% did not wear them appropriately and about 10-14% did not wear PPE at all. A mere 7 out of 50 alone used hand gel. Overall the donning and doffing of PPE was not being followed and adhered to according to the standards from PHE as per the first Audit. In particular, during donning only 1/3rd of them donned the PPE as per guidance. Likewise, the doffing technique was also poor, with only half of them removing the apron and mask correctly. Unfortunately, only 7 of the 50 people were observed to have used hand gel in between the doffing. This could be potentially increasing the risk of the spread of the coronavirus.
We had trained almost 150 staff members in the Heddfan unit with regard to PPE/ donning and doffing.
Handwashing prior to donning was achieved by all the staff. All the staff, that is 100 % of them adhered to the donning technique in line with the guidance in comparison to just 64% during the first Audit. Whilst hardly just 1/2 to 2/3rd of the staff followed the doffing technique adequately, the second audit showed that only 2 of the 50 staff did not follow the guidance. A meagre/ handful of them followed the utilisation of hand gel in between the tasks of doffing during the first Audit. Almost 90% of them followed the technique properly during the second Audit. Thus showing that the PPE training was successful.
ConclusionFollowing the PPE training that was provided to them there was a good response from the staff and this went on to show how effectively we have managed the prevention/ contamination of virus in our unit.
Are the rapid tranquilisation nice guidelines adhered to, in patients with agitated/aggressive behavior? a QIP
- Asha Dhandapani, Sathyan Soundararajan, Rajvinder Sambhi
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S184-S185
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
To explore whether the NICE guidelines for rapid tranquilisation are adhered to in the Psychiatric intensive care unit (PICU/ Tryweryn).
MethodData were collected by core trainees. Standards were taken from NICE guidelines NG10. All patients who had received rapid tranquilisation, that were in PICU from August 2019 to February 2020 were considered in this a.
ResultDuring the first PDSA, we discussed with the staff in the ward regarding the protocol. Prior to actually starting the second audit, the adherence was noted to be low. However following persistence and having created a protocol jointly with the ward manager, we could see the difference. The staff were appreciated for their efforts in maintaining 100% adherence. The same was intended to be continued with some positive reinforcement from the auditing team. Over the first 2 months, 12 patients received Rapid Tranquilisation. Out of these 12, we randomly selected 4 patients to find the adherence of the NICE guidelines to be 100 per cent. The predictions regarding the adherence to protocol showed that the PDSA was successful.
During the second PDSA, the adherence was 100% again. The adherence to the protocol has been followed for not just the sample that was selected, but for the entire set of patients who received the Rapid Tranquilisation. Following this QIP, we formatted the proforma which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and response to medication.
ConclusionThe utilisation of de-escalation techniques and behavioural support plans that was person-centred in turn brought down the rate of Rapid Tranquilisation successfully. Thus placing our PICU as having the least restraints in the UK in 2019 (Second least 3/ month). Our PICU was awarded the prestigious Nursing Times Team of the Year Award for their pioneering work.
Following this QIP, we then formatted the proforma for Rapid Tranquilisation which included the services to be provided/ actions to be taken, Post Rapid Tranquilisation physical health monitoring and patients response to medication. The PICU will continue to maintain this 100% standard and we would then consider extending the Audit to both Open wards and PICU in entire North Wales.
An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales
- Asha Dhandapani, Sathyan Soundararajan, Manjula Simiyon, Vinila Zachariah, Rajvinder Sambhi
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S75
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
To ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.
MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.
We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.
Our aim is to achieve 100 % compliance in clerking
ResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.
Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.
ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.
Apart from this, it also is needed for further continuity of care.
Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.
We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.
We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.
We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic
Junior doctor daytime bleep audit
- Asha Dhandapani, Sathyan Soundararajan, Rajvinder Sambhi
-
- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S75
-
- Article
-
- You have access Access
- Open access
- Export citation
-
Aims
There had been ongoing concerns with regard to covering daytime duty bleeps across the three sites in the Mental health Department, BCUHB, North Wales.
Frequent empty on-call slots meant some doctors being asked to hold the bleep between 9-5 in-order to cover the vacancy.
Some felt this added to the existing workload and that it was unfair and unsafe.
This issue was raised during a supervision session with the Educational supervisor, North Wales and an initial data collection was suggested.
MethodData were collected over 2 week period to look at the Daytime bleep duties between 9 am to 5 pm
We hoped the data would demonstrate certain patterns of the task being asked to perform.
ResultThe total number of bleeps were noted to be 249
Discharge notification and prescription writing was noted to be the commonest reason for bleep in East and Central while Routine review and Discharge notification was the reason to be bleeped major number of times in the West
Nearly 70% and 90% of the bleeps were found to be appropriate by the East and West respectively, while only a mere 15% were reported so in Central.
While 30% of these bleeps in the West were considered to be deferred, 70% bleeps were deferrable in the East and almost 95% in Central.
The general trend in all 3 centres was as follows:
All three centres have high numbers of bleeps for discharge, prescribing tasks and routine patient reviews
Most think planned discharge paperwork could be done in advance and jobs can be deferred if there is a ward/team doctor available
ConclusionA simple solution could be some jobs being planned ahead (e.g TTO/Discharge Summaries, Re-write charts) and done by the team/ward doctor. ECG could be arranged to be done by nurses/ECG technicians. Some nurses/HCAs are trained in phlebotomy, however, they have not been utilising the skills. That needed to be reinforced in safety huddles meeting.
Apart from these suggestions, we were also wondering about the impact of the service models and how the juniors placed in the community mental health unit could stay involved in their team inpatients
Psychiatry for Dermatologists: An Update
- Rajvinder Sambhi, Peter Lepping
-
- Journal:
- European Psychiatry / Volume 25 / Issue S1 / 2010
- Published online by Cambridge University Press:
- 17 April 2020, 25-E169
-
- Article
-
- You have access Access
- Export citation
-
This presentation highlights the need for a close link between the psychiatrists and the dermatologists. There is undoubtedly a high prevalence of psychiatric conditions amongst both the dermatology outpatients and the inpatients. The psychiatric symptoms can be either a manifestation of distress secondary to the primary dermatological pathology or a primary psychiatric condition presenting as dermatological pathology. In both the cases, the risk has to be recognised as the distress can lead to a suicide attempt and therefore, it can be challenging to both the treating dermatologist and the psychiatrist as the patient can actively refuse treatment because of the stigma associated with the label of having a psychiatric ailment. This presentation mentions various psychiatric conditions with regard to dermatology and specific issues about the psychotropic and dermatological medications.
Mental disorders which can present in the dermatology clinics are anxiety, depression, obsessive-compulsive disorder, body dysmorphic disorder, delusional parasitosis or delusional infestation and dermatitis artefacta. It can be quite helpful for the dermatologist to be aware of the symptoms of these disorders whether primarily psychiatric or secondary to the dermatological pathology. The issues regarding medication are specifically with regard to Isotretinoin and combination treatments. An association had been reported between oral isotretinoin and mood changes, particularly depression and suicide but a recent systematic review did not find any conclusive evidence for such an association. Combination of cytotoxic agents with clozapine can exacerbate the risk of reduction in white blood cell counts. There is an increased risk of ventricular arrhythmias with the combination of erythromycin and antipsychotics. An increased risk of convulsions with a combination of erythromycin and clozapine has been mentioned. There are particular concerns about the over the counter use of St. John's wort, used in mild and moderate depressions with regard to interaction with various dermatological agents.
In summary, a close liaison between dermatologists and psychiatrists is essential to provide holistic care for patients presenting with dermatological pathology.
Clinical relevance of findings in trials of antipsychotics: systematic review
- Peter Lepping, Rajvinder S. Sambhi, Richard Whittington, Steven Lane, Rob Poole
-
- Journal:
- The British Journal of Psychiatry / Volume 198 / Issue 5 / May 2011
- Published online by Cambridge University Press:
- 02 January 2018, pp. 341-345
- Print publication:
- May 2011
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Background
There is concern over the methods used to evaluate antipsychotic drugs.
AimsTo assess the clinical relevance of findings in the literature.
MethodA systematic review identified studies of antipsychotics that used the Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS). A published method of translating these into Clinical Global Impression – Change scale (CGI–C) scores was used to measure clinical relevance.
ResultsIn total 98 data-sets were included in the BPRS analysis and 202 data-sets in the PANSS analysis. When aggregated scores were translated into notional CGI–C scores, most drugs reached ‘minimal improvement’ on the BPRS, but few reached that level for PANSS. This was true of both first- and second-generation drugs, including clozapine. Amisulpride and olanzapine had better than average CGI–C scores.
ConclusionsOur findings show improvements of limited clinical relevance. The CGI–C scores were better for the BPRS than for the PANSS.
Early termination of cognitive-behavioural interventions: literature review
- Alberto Salmoiraghi, Rajvinder Sambhi
-
- Journal:
- The Psychiatrist / Volume 34 / Issue 12 / December 2010
- Published online by Cambridge University Press:
- 02 January 2018, pp. 529-532
- Print publication:
- December 2010
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Aims and method
The evidence of the efficacy of cognitive-behavioural interventions is well established. Despite this, clinicians often face a consistent number of not attended appointments or early treatment discontinuation rates. This paper reviews the literature to date regarding the possible causes of early termination of cognitive-behavioural interventions. A literature search was done using Medline, PsycINFO, Embase and the Cochrane Library.
ResultsWe reviewed 14 articles. Out of these, two were randomised controlled trials, one was a controlled trial and the rest were cohort studies. Drop-out was defined differently across papers. There are many factors that may affect early treatment discontinuation rates and they are described individually.
Clinical implicationsThere does not appear to be a single strong predictor of early treatment discontinuation. Specific literature relating to cognitive-behavioural therapy is scarce. However, some factors such as young age, education level and psychopathology appear to be more strongly associated with early treatment discontinuation than others.