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Identification of Cognitive Impairment in Cardiovascular Rehabilitation: A Pilot Cross-Sectional Study
- Qutub Jamali, Suraju Adeyemo, Ahmed Abdelgawad, Sucharitha Narayan, Mirza Najiullah Beg, Salman Karim, Chukwuma Oraegbunam, Kalpesh Solanki
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S40-S41
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Aims
Cardiac Rehabilitation (CR) is a multidisciplinary intervention for people after an adverse cardiac event to improve their physical, psychological and social functioning. The risk factors of cardiac disease and dementia are similar. This cross sectional study aims to determine whether adding memory assessment to a CR program would improve early detection of cognitive impairment. Therefore, the research question is- “Can adding a memory assessment to the cardiac rehabilitation program improve early detection of cognitive impairment in people with cardiac disease?”.
MethodsStudy ethical approval was granted by Yorkshire & The Humber - Sheffield Research Ethics Committee (reference 20/YH/0146) and the NHS Health Research Authority (project reference 273763). The Lancashire & South Cumbria NHS Foundation Trust accepted the role and responsibilities of study sponsorship. Participants underwent cognitive screening and the data obtained was divided into: - 1- History of memory problems before and after the adverse cardiac event. 2- No memory problems before but presents after. 3- No memory problems before and after.
ResultsDuring the study period, 48 participants who were at the cardiac rehabilitation program expressed their interest to patriciate in the study. Out of 48 participants who expressed their interest in participating in the study, 30 of them did not engage beyond expressing their interest and 18 out of 48 completed the assessment. The studied sample was categorized into three groups according to the relation between the onset of the cognitive decline and the onset of the cardiac condition: those with no history of cognitive decline (22.2%), cognitive decline following the onset of the cardiac condition (27.8 %) and cognitive decline before and after the onset of the cardiac condition (50 %). Comparing the number of the participants in the studied sample who has history of cognitive decline revealed that there was statistically significant difference between the number of participants who have history of cognitive decline and the other group which demonstrated no decline in their cognitive function (p = 0.031). On correlating medications variables with all domains of cognitive functions assessments done by using ACE-III, we found that participants who are taking statins as regular medications had higher mean scores for visuospatial subtest than the other group of participants who are not taking statins and this difference was statistically significant (p = 0.012).
ConclusionThis study indicate that CR could potentially enable early detection of cognitive impairment, which could be either reversible or irreversible. However, a longitudinal study of larger scale is required for proper implementation of cognitive assessment in cardiac rehabilitation.
Acute Psychotic Episode Due to Milk-Alkaline Syndrome
- Suraju Adeyemo, John Erfani, Attique Shafiq, Collins Chukwuma, Mark Worthington
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S117
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Aims/ Background
: Milk-alkali syndrome is a medical condition, which could present with psychiatric manifestations. It is caused by hypercalcemia resulting from the ingestion of large amounts of calcium and absorbable alkali. The core symptoms include hypercalcemia, metabolic alkalosis, and renal failure. Diagnosing this syndrome requires a high index of suspicion. The aim of this paper is to describe the case of Mrs. C who had psychotic symptoms because of Milk-Alkaline syndrome
Methods/ Case ReportMrs. C was a 75-year-old white British female with a previous history of anorexia nervosa who has been clinically stable for more than 15 years. She was discharged by the community mental health services about 11 years ago but has been on a repeated dose of Gaviscon for about 8 years.
She presented to the accident and emergency (A and E) unit with a history of confusion, unsteadiness, paranoid beliefs, low mood, and reduced rate of speech. No history of infection or other physical health concerns. Routine blood showed increased calcium 3.41(2.2-2.60) and a reduced potassium level 2.9 (3.5-5.3). CT head scan did not show any acute changes.
She was stabilized and transferred to the ward for further management.
While on the ward, she had a diagnosis of Milk-Alkaline syndrome with psychiatric manifestation. Gaviscon was discontinued because the medics felt this was responsible for the electrolyte imbalance. She was also referred to the mental health liaison team (MHLT).
Following the mental health liaison team review, Mrs. C's psychiatric presentation was suspected to have been probably related to her medical condition. After a few weeks on the ward, her electrolyte became normalized; adjusted Ca 2.72 (2.2-2.6), serum ca 2.74(2.2-2.6). She had a follow-up review by the mental health team that showed her psychosis had also resolved. No medication was prescribed for her presentation. She was subsequently discharged from MHLT and referred to the GP for follow-up.
Results/ Discussionprevious case-report have shown a suspected link between Milk alkaline syndrome and acute psychosis, although the reasons for this have not been understood. The current case further emphasized this link. What is not evident however is if there were other physical health issues that might have also contributed to the patient's initial presentation.
ConclusionDiagnosis of Milk-Alkaline Syndrome requires a high index of suspicion, missing this could lead to inappropriate use of medication. As a psychiatrist, this case has shown the importance of adequate investigation before making a definitive diagnosis, especially in a psychiatric liaison setting.
Acute Psychosis in Hashimoto's Thyroiditis
- Suraju Adeyemo, John Erfani, Attique Shafiq, Collins Chukwuma, Charles Nwokonko, Mark Worthington
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S117-S118
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Aims
Hashimoto thyroiditis was discovered by Hakaru Hashimoto in 1912 but became more recognized in the 1950s. It is an autoimmune disorder with an incidence rate of about 0.8/1000/year in men and 3.5/1000/year in women. The inheritance pattern of Hashimoto thyroiditis is not fully understood and diagnosing this condition could be challenging. Among many presentations, its effects on mental health can lead to a greater burden on a patient. There has been an increased report of acute psychiatric symptoms in this condition. Literature has described a wide spectrum of psychiatric manifestations occurring prior to, during, and after this illness. The aim of this report is to describe a woman with diagnosed psychosis secondary to Hashimoto's thyroiditis.
MethodsMs S is a 22-year-old female who was admitted in January 2021 to the emergency department of Hospital B with a history of sudden behavioural changes: agitation, responding to unseen stimuli, and bizarre behaviour.
Her previous record reveals that she had a similar presentation in November 2019, managed with antipsychotics. The diagnosis at the time was unclear however; meningoencephalitis was suspected and later for NDMA encephalitis. After 4 months of admission to Hospital A, her behavioural changes remained unresolved but she was discharged to a care home with 2:1 support. She remained in the care home until further deterioration, which warranted a further admission to Hospital B.
Following a psychiatric review in Hospital B, she was initially diagnosed with an Acute psychotic episode with query cause and managed with IM Aripiprazole.
Due to physical health concerns and the unclear nature of her diagnosis, she was transferred to the acute medical ward and further investigation was requested.
Her result showed significantly elevated Thyroid Peroxidase Antibodies of 845 IU/ml (normal up to 24 IU/ml), lumbar puncture and NMDA antibody test were both normal, TSH level was raised to 6.73. Following further discussion with the medical team, a diagnosis of Psychosis secondary to Hashimoto's thyroiditis was made.
She was co-managed by the psychiatrist, endocrinologist and others.
Ms S became settled but due to residual psychosis, she was transferred to an inpatient psychiatric ward where her psychosis resolved, and was discharged back to the community mental health services.
Results/DiscussionAs a result of the late diagnosis of her condition and delayed hospital stay, Ms. S developed a lot of mistrust for the services as she believe that the 19-month delay had significantly impacted her quality of life.
ConclusionDiagnosis of psychosis secondary to Hashimoto's thyroiditis requires a high index of suspicion, missing this could lead to inappropriate use of medication and increased mobility.
Perception of Doctors Attending Association of Black Psychiatrists-UK Led CASC Preparatory Course
- Suraju Adeyemo, Olufikunayo Manuwa, Theresa Ugalahi, Nneamaka Asiodu, Sewanu Awhangansi, Babatunde Odebiyi, Nwife Akhator-Eneka, Mojisola Adeniji, Chukwuma Oraegbunam
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S14
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Aims
Within the United Kingdom, there has been differential attainment in academic performance and career progression between International Medical graduates (IMG) and UK medical school graduates. Reasons reported for these differences include; poor relationships with trainers, cultural differences, and inadequate support. To close this differential attainment, effective interventions to support IMGs are indicated. This need for diversity led to the creation of the Association of Black Psychiatrists-UK Tutorial group (The-Tutors). The Tutors is a free online CASC preparatory group that started about 2-years ago and is tailored to meet the specific needs of black doctors sitting the Royal College of Psychiatrists examination. over 100-black Doctors have benefited from the group. This study was conducted to evaluate the experience of these doctors.
MethodsThe sampling frame was the population of doctors who attended The-Tutors before sitting the CASC examination. Data were collected on socio-demographic characteristics, past psychiatry training experiences, and participants' experience toward preparation and passing CASC.
An online questionnaire was completed and this was distributed through social media (closed WhatsApp groups).
Responses were anonymous.
ResultsTotal participants were 33, out of which 20 (60.6%) had passed the CASC examination while 13 (39.4%) are still awaiting results.
The majority (51.5%) of the participants had only international training in Psychiatry, 27.3% had their training in the UK, and 12.1% had both, while 9.1% had no formal-psychiatric training.
Most 21(63.6%) participants indicated that the group was ‘extremely useful’ for CASC preparation.
In terms of comparing experience in this group with other CASC preparatory groups, all the respondents found The Tutors group more helpful; 16(48.5%) indicated that the group was ‘extremely helpful’, 14(42.4%) ‘very helpful’ and 9.1% “moderately helpful”.
Most of the participants (75.8%) indicated that they were “extremely likely” to recommend the group to others.
The majority (>65%) of respondents reported that The-Tutors helped in improving their knowledge, communication skills, confidence approaching the examination, and motivation to study.
Close to half (48.5%) of participants who had passed the CASC examination indicated that The-Tutor was “extremely helpful” toward their success.
ConclusionThis study has shown positive experiences of IMG especially of Black ethnic group attending an all- Black-led CASC preparatory group. This could be an indication that support groups specifically targeted toward the needs of IMG could help lead to an increase in success rates in UK examinations.
Development and feasibility assessment of a collaborative stepped care intervention for management of depression in the mental health in primary care (MeHPriC) project, Lagos, Nigeria
- Abiodun O. Adewuya, Tomilola Adewumi, Olufisayo Momodu, Olushola Olibamoyo, Olabanji Adesoji, Adedayo Adegbokun, Suraju Adeyemo, Olufikunayo Manuwa, Dapo Adegbaju
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- Journal:
- Psychological Medicine / Volume 49 / Issue 13 / October 2019
- Published online by Cambridge University Press:
- 17 October 2018, pp. 2149-2157
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Background
This study aimed to develop and test the feasibility of a primary care worker-led psychological intervention as the main feature of a collaborative stepped care for depression that is effective, affordable, culturally acceptable, tailored to patients’ clinical condition and easily integrate-able into the primary care schedule in Nigeria.
MethodsUsing the Medical Research Council framework, in the first stage (modelling/theoretical development), experts reviewed and distilled evidence from literature to form the intervention components. In the second (formative) stage, local stakeholders were consulted on the practical application and feasibility of the proposed intervention. The third (piloting) stage involved testing for the clinical efficacy and acceptability of the components of the draft intervention
ResultsThe final intervention components included a 2-stage screening (red-flagging and further evaluation), psychoeducation, low-intensity psychological therapy (problem-solving therapy for primary care), antidepressant prescription, proactive mobile telephony adherence support and referral to the mental health specialist if needed. At 3 months, 71.6% of depressed patients on the intervention improved. The intervention was perceived to be acceptable and useful by over 70% of health workers and clients and had high ratings (>70% score) by expert panels on intervention simplicity, facilitation strategies, and quality of delivery.
ConclusionsThe development and feasibility testing of our integrated intervention encompassed review of current literature, expert opinions and consultation with local stakeholders and end users. Our intervention package was largely deemed acceptable, relevant, useful, and feasible. Important lessons learnt with this process will help in future intervention developments.