A systematic review and meta-analysis of neurological soft signs in relatives of people with schizophrenia

<p>Abstract</p> <p>Background</p> <p>Neurological soft signs are subtle but observable impairments in motor and sensory functions that are not localized to a specific area of the brain. Neurological soft signs are common in schizophrenia. It has been established that soft signs meet two of five criteria for an endophenotype, namely: association with the illness, and state independence. This review investigated whether soft signs met a further criterion for an endophenotype, namely familial association. It was hypothesized that if familial association were present then neurological soft signs would be: (a) more common in first-degree relatives of people with schizophrenia than in controls; and (b) more common in people with schizophrenia than in their first-degree relatives.</p> <p>Method</p> <p>A systematic search identified potentially eligible studies in the EMBASE (1980-2011), OVID - MEDLINE (1950-2011) and PsycINFO (1806-2011) databases. Studies were included if they carried out a three-way comparison of levels of soft signs between people with schizophrenia, their first-degree relatives, and normal controls. Data were extracted independently by two reviewers and cross-checked by double entry.</p> <p>Results</p> <p>After screening 8678 abstracts, seven studies with 1553 participants were identified. Neurological soft signs were significantly more common in first-degree relatives of people with schizophrenia than in controls (pooled standardised mean difference (SMD) 1.24, 95% confidence interval (c.i) 0.59-1.89). Neurological soft signs were also significantly more common in people with schizophrenia than in their first-degree relatives (SMD 0.92, 95% c.i 0.64-1.20). Sensitivity analyses examining the effects of age and group blinding did not significantly alter the main findings.</p> <p>Conclusions</p> <p>Both hypotheses were confirmed, suggesting that the distribution of neurological soft signs in people with schizophrenia and their first-degree relatives is consistent with the endophenotype criterion of familial association.</p

Clinical audits by trainee doctors: Obstacles and solutions

PurposeThis paper aims to investigate trainee doctors' experience of clinical audits and to explore solutions for identified problems.Design/methodology/approachPsychiatry trainees from all the deaneries in the UK were invited to participate in a semi‐qualitative online survey. It focused on estimating the quantity and quality of the clinical audits done by the trainees, exploring their experience and possible solutions for identified problems. Descriptive statistics and framework analysis were used to analyse the data.FindingsA total of 2,267 audits were carried out by 504 respondents. Of the respondents, 42 per cent completed at least one audit‐cycle. Nearly half of the audits were presented locally and 37 per cent were submitted to the local audit departments. Recommendations from two‐thirds of all the audits went unnoticed because of inadequate dissemination and implementation. Suggestions for improvement included: formal training, participation by non‐medical colleagues, emphasis on quality of audits rather than quantity, and better co‐ordination by audit departments.Practical implicationsTrainees identify that local audits do not result in service improvement. Suggested changes may lead to improved effectiveness of the local clinical audit programmes.Originality/valueAudit activities by the trainee doctors lay the foundation of their involvement in clinical governance later on. To the best of the authors' knowledge, this study is the first of its kind to capture the clinical audit activities by the trainee doctors at the national level in the UK.</jats:sec

Pandemics and pre-existing mental illness: A systematic review and meta-analysis

Introduction: Pandemics are known to affect mental health of the general population and various at-risk groups like healthcare workers, students and people with chronic medical diseases. However, not much is known of the mental health of people with pre-existing mental illness during a pandemic. This systematic review and meta-analysis investigates, whether people with pre-existing mental illness experience an increase in mental health symptoms and experience more hospitalizations during a pandemic. Materials and methods: A systematic search was conducted in the EMBASE, OVID-MEDLINE and PsycINFO databases to identify potentially eligible studies. Data were extracted independently and continuous data were used in calculating pooled effect sizes of standardized mean difference (SMD) using the random-effects model. Results: Of 1791 records reviewed 15 studies were included. People with pre-existing mental illness have significantly higher psychiatric symptoms, anxiety symptoms and depressive symptoms compared to controls during a pandemic with pooled effect sizes (SMD) of 0.593 (95% confidence interval (CI) 0.46 to 0.72), 0.616 (95% CI 0.49 to 0.73) and 0.597 (95% CI 0.38 to 0.80) respectively. Studies also found a reduction in psychiatric hospitalizations and utilization of psychiatric services during pandemics. Conclusion: The review highlights the need for mental health services to address the increased mental health symptoms in people with pre-existing mental illnesses during a pandemic. Future research should focus on better designed controlled studies of discrete illness groups, so as to provide a robust basis for policy makers to plan appropriate level of support and care for people with mental illness during a pandemic

Pandemics and pre-existing mental illness: A systematic review and meta-analysis

Introduction: Pandemics are known to affect mental health of the general population and various at-risk groups like healthcare workers, students and people with chronic medical diseases. However, not much is known of the mental health of people with pre-existing mental illness during a pandemic. This systematic review and meta-analysis investigates, whether people with pre-existing mental illness experience an increase in mental health symptoms and experience more hospitalizations during a pandemic. Materials and methods: A systematic search was conducted in the EMBASE, OVID-MEDLINE and PsycINFO databases to identify potentially eligible studies. Data were extracted independently and continuous data were used in calculating pooled effect sizes of standardized mean difference (SMD) using the random-effects model. Results: Of 1791 records reviewed 15 studies were included. People with pre-existing mental illness have significantly higher psychiatric symptoms, anxiety symptoms and depressive symptoms compared to controls during a pandemic with pooled effect sizes (SMD) of 0.593 (95% confidence interval (CI) 0.46 to 0.72), 0.616 (95% CI 0.49 to 0.73) and 0.597 (95% CI 0.38 to 0.80) respectively. Studies also found a reduction in psychiatric hospitalizations and utilization of psychiatric services during pandemics. Conclusion: The review highlights the need for mental health services to address the increased mental health symptoms in people with pre-existing mental illnesses during a pandemic. Future research should focus on better designed controlled studies of discrete illness groups, so as to provide a robust basis for policy makers to plan appropriate level of support and care for people with mental illness during a pandemic