Relevance of pre-morbid cognitive impairment of schizophrenia

This thesis begins with an exploration of the historical associations between learning disability and schizophrenia, which leads to the modern supposition that schizophrenia is commoner in people with learning disability than the normal population. A critical evaluation of both community and hospital epidemiological studies indicates that the point prevalence of schizophrenia in people with mild learning disability is around 3% i.e. around three times that expected in the normal population. Five possible mechanisms to account for this increase are postulated and discussed: a chance co-occurrence, a common aetiology, an epiphenomenon, a severe schizophrenia and a 'de novo' disease

A study of the Fife and Kinross District Asylum 1866-1899

This thesis aims to illuminate the hitherto neglected area of the Scottish Victorian Pauper Asylum. It provides a detailed study of one specific institution, The Fife and Kinross District Asylum between the years 1866 and 1899. A wealth of archival material is available for this period, including admission registers, consecutive casebooks, post mortem and annual reports. This has afforded a unique insight into asylum life, and the information obtained has enabled the thesis to be divided into two main sections. The first aims to provide an account of the establishment of the Fife Asylum within its historical context, with particular reference to its doctors and attendants. The second part examines the patient population and focuses on a casenote study of 337 male patients admitted between 1874 and 1899. Sociodemographic characteristics, psychopathology, Nineteenth Century diagnoses, length of stay and outcome are all examined for this population. An attempt has also been made to re-diagnose the psychopathology identified in terms of the Research Diagnostic Criteria of Spitzer et al (1978). The findings indicate that the Fife Asylum differed from its English counterparts in several important respects. Although inpatient numbers rose as the century progressed there was no evidence of overcrowding with chronic patients, or an excess of 'organic' pathology, as was seen in English Asylums. These and other distinguishing features are examined critically and discussed in relation to the innovative styles of patient management pioneered at the Fife Asylum in the latter half of the Nineteenth Century

Do we need a core-curriculum for medical students? A scoping review

Objective The General Medical Council (GMC) recommends medical schools to develop and implement curricula enabling students to achieve the required learning outcomes. UK medical schools follow the GMC’s Outcomes for Graduates, which are generic. GMC plans to introduce a national Medical Licencing Assessment (MLA) for medical graduates wanting to practice medicine in the UK in 2022. With no standardised or unified undergraduate (UG) curriculum in UK, various specialities have expressed concerns about not being represented in medical schools and developed specialty-specific core-curricula.The aim of this review was to identify learned bodies who have developed a core-curriculum for UK medical schools and highlight the drivers, gaps and future approaches to curricular development and implementation. Methods A literature search was conducted using online databases (EMBASE, MEDLINE, ERIC, HMIC, PubMed and CDSR), search engines, and related websites (Google & Google Scholar, Department of Health, GMC and BMA) for relevant articles from 1996 to 5th March 2019 (~20 years). A methodological framework to map the key concepts of undergraduate medical curriculum was followed. Any relevant body with a core-curriculum for UK medical undergraduates was included.Results A total of 1283 articles were analysed with 31 articles included in the qualitative synthesis, comprising of 26 specialties (clinical n=18, foundation subjects n=4, professionalism related n=4). WHO, European and national (e.g. Royal Colleges of UK) specialty bodies provided specific core learning outcomes for medical graduates. Patient safety, disease burden, needs of society and inadequate preparedness of medical graduates were drivers for development of these curricula.ConclusionsThis is the first comprehensive review of literature on undergraduate core-curricula recommending minimum standards on knowledge and skills, in alignment with GMC’s outcomes for graduates for all UK medical students. Adopting and assessing unified standards would help reduce variability across UK medical schools for both generic and specialty-specific competencies

Experiences of Widening Participation students in undergraduate medical education in the UK: a qualitative systematic review protocol

Objective: The objective of this review is to characterize the experiences of Widening Participation students in undergraduate medical education in the United Kingdom (UK).Introduction: Most Widening Participation research in the UK is focused on medical school recruitment. Although this is important, there is a paucity of research examining whether the experience of medical school itself is an equal experience for both traditional and Widening Participation students. The aim of this review is to explore and to characterize the experiences of Widening Participation students within medical education during their studies in the UK.Inclusion criteria: This review will include qualitative research conducted in the UK examining any aspect of the lived experience of undergraduate medical education according to Widening Participation students, including identity formation, learning experience in pre-clinical environments and clinical placements, and the relation to social, cultural, and financial capital.Methods: The study will consider articles found through searching the databases MEDLINE, PubMed, Web of Science, CINAHL, EMBASE, PsycINFO, and ERIC, as well as gray literature. Studies published from 2000 onwards in the English language will be included. Studies will be assessed against the inclusion criteria at all stages by two independent reviewers. Eligible studies will be critically appraised for methodological quality. Regardless of methodological quality, all studies retrieved will be included in the review. The final synthesized findings will be graded according to the ConQual approach

The experience of widening participation students in undergraduate medical education in the UK: A qualitative systematic review

Most Widening Participation (WP) research is focused on medical school recruitment; there is a paucity of research examining whether the experience of medical school itself is an equal experience for both 'traditional' and WP students. This qualitative systematic review used the Joanna Briggs Institute meta-aggregative approach to characterise the experience of undergraduate medical education in the UK from the perspective of WP students. Seven databases were searched, 27 studies were critically appraised, and 208 findings were grouped into 12 categories and 4 synthesised findings. The majority of the research found relates to ethnic minority groups, with reports of other WP groups being less frequent. Whilst WP programmes attempt to alleviate disadvantages prior to entering university, our findings suggest that difficulties follow WP students into medical school. Unfamiliarity with higher education and lack of representation of WP staff in faculty can deter help-seeking behaviour and result in lack of trust. Furthermore, students from different backgrounds can find their identity conflicted upon entering medical school. Despite difficulties in establishing social networks with 'traditional' medical student peers, WP students form strong relationships with students from similar backgrounds. Ultimately, these students find that the uniqueness of their experience is a useful tool for communicating with diverse patients which they come across and are able to overcome adversity with the help of a supportive institution

Usability: An introduction to and literature review of usability testing for educational resources in radiation oncology

Usability, or the ease with which something can be used, is a key aspect in ensuring end-users can achieve the best possible outcomes from a given educational resource. Ideally usability testing should take place iteratively throughout the design of the resource, and there are several approaches for undertaking usability testing described in the wider literature. Within radiation oncology education, the extent to which usability testing occurs remains unclear. This literature review aimed to assess current practice and provide a practical introduction to usability testing for educational resource design within radiation oncology.Two web databases were searched for articles describing planned or completed usability testing during the design of a radiation oncology educational resource. Fifteen studies were identified. Data was gathered describing the type of usability testing performed, the number of cycles of testing and the number of test subjects. Articles described design of educational resources for both patients and trainees, with the number of test subjects ranging from 8 to 18. Various testing methods were used, including questionnaires, think aloud studies and heuristic evaluation. Usability testing comprised a range of single cycle through to several rounds of testing.Through illustrative examples identified in the literature review, we demonstrate that usability testing is feasible and beneficial for educational resources varying in size and context. In doing so we hope to encourage radiation oncologists to incorporate usability testing into future educational resource design

Neurological Signs at the First Psychotic Episode as Correlates of Long-Term Outcome:Results From the AESOP-10 Study

Minor neurological signs are subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts present in excess in the early stages of psychosis. Still, it remains unclear whether at least some of these signs represent trait or state markers for psychosis and whether they are markers of long-term disease outcome of clinical utility. We examined the relationship between neurological function at illness onset assessed with the Neurological Evaluation Scale and subsequent illness course in 233 patients from AESOP-10 (Aetiology and Ethnicity in Schizophrenia and Other Psychoses), a 10-year follow-up study of a population-based cohort of individuals recruited at the time of their first episode of psychosis in the United Kingdom. In 56 of these patients, we also explored changes in neurological function over time. We included a group of 172 individuals without psychosis as controls. After 10 years, 147 (63%) patients had developed a non-remitting course of illness, and 86 (37%) a remitting course. Already at first presentation, patients who developed a non-remitting course had significantly more primary, motor coordination, and total signs than both remitting patients and healthy controls. While Motor Coordination signs did not change over time, rates of Primary, Sensory Integration, and Total signs increased, independently of illness course type. These findings suggest that motor coordination problems could be a useful early, quick, and easily detectable marker of subsequent clinical outcome. With other motor abnormalities, a measure of motor incoordination could contribute to the identification of the most vulnerable individuals, who could benefit from targeted and more assertive treatment approaches

Clinical predictors of antipsychotic treatment resistance: Development and internal validation of a prognostic prediction model by the STRATA-G consortium

Introduction Our aim was to, firstly, identify characteristics at first-episode of psychosis that are associated with later antipsychotic treatment resistance (TR) and, secondly, to develop a parsimonious prediction model for TR. Methods We combined data from ten prospective, first-episode psychosis cohorts from across Europe and categorised patients as TR or non-treatment resistant (NTR) after a mean follow up of 4.18 years (s.d. = 3.20) for secondary data analysis. We identified a list of potential predictors from clinical and demographic data recorded at first-episode. These potential predictors were entered in two models: a multivariable logistic regression to identify which were independently associated with TR and a penalised logistic regression, which performed variable selection, to produce a parsimonious prediction model. This model was internally validated using a 5-fold, 50-repeat cross-validation optimism-correction. Results Our sample consisted of N = 2216 participants of which 385 (17 %) developed TR. Younger age of psychosis onset and fewer years in education were independently associated with increased odds of developing TR. The prediction model selected 7 out of 17 variables that, when combined, could quantify the risk of being TR better than chance. These included age of onset, years in education, gender, BMI, relationship status, alcohol use, and positive symptoms. The optimism-corrected area under the curve was 0.59 (accuracy = 64 %, sensitivity = 48 %, and specificity = 76 %). Implications Our findings show that treatment resistance can be predicted, at first-episode of psychosis. Pending a model update and external validation, we demonstrate the potential value of prediction models for TR.Funding: This work was supported by a Stratified Medicine Programme grant to JHM from the Medical Research Council (grant number MR/L011794/1 which funded the research and supported S.E.S., D.A., A.F.P, L.K., R.M.M., D.S., J.T.R.W, & J.H.M.); funding from the National Institute for Health Research Biomedical Research Centre at South London and Maudsley National Health Service Foundation Trust and King's College London to D.A. and D.S; and funding from the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London at King's College Hospital National Health Service Foundation Trust to S.E.S. The views expressed are those of the author(s) and not necessarily those of the Medical Research Council, National Health Service, the National Institute for Health Research, or the Department of Health. The AESOP (London, UK) cohort was funded by the UK Medical Research Council (Ref: G0500817). The Belfast (UK) cohort was funded by the Research and Development Office of Northern Ireland. The Bologna (Italy) cohort was funded by the European Community's Seventh Framework Program under grant agreement (agreement No.HEALTH-F2-2010–241909, Project EU-GEI). The GAP (London, UK) cohort was funded by the UK National Institute of Health Research(NIHR) Specialist Biomedical Research Centre for Mental Health, South London and Maudsley NHS Mental Health Foundation Trust (SLaM) and the Institute of Psychiatry, Psychology, and Neuroscience at King's College London; Psychiatry Research Trust; Maudsley Charity Research Fund; and the European Community's Seventh Framework Program grant (agreement No. HEALTH-F2-2009-241909, Project EU-GEI). The Lausanne (Switzerland) cohort was funded by the Swiss National Science Foundation (no. 320030_135736/1 to P.C. and K.Q.D., no 320030-120686, 324730-144064 and 320030-173211 to C.B.E and P.C., and no 171804 to LA); National Center of Competence in Research (NCCR) “SYNAPSY - The Synaptic Bases of Mental Diseases” from the Swiss National Science Foundation (no 51AU40_125759 to PC and KQD); and Fondation Alamaya (to KQD). The Oslo (Norway) cohort was funded by the Research Council of Norway (#223273/F50, under the Centers of Excellence funding scheme, #300309, #283798) and the South-Eastern Norway Regional Health Authority (#2006233, #2006258, #2011085, #2014102, #2015088 to IM, #2017-112). The Paris (France) cohort was funded by European Community's Seventh Framework Program grant (agreement No. HEALTH-F2-2010–241909, Project EU-GEI). The Prague (Czech Republic) cohort was funded by the Ministry of Health of the Czech Republic (Grant Number: NU20-04-00393). The Santander (Spain) cohort was funded by the following grants (to B.C.F): Instituto de Salud Carlos III, FIS 00/3095, PI020499, PI050427, PI060507, Plan Nacional de Drogas Research Grant 2005-Orden sco/3246/2004, and SENY Fundatio Research Grant CI 2005-0308007, Fundacion Marques de Valdecilla A/02/07 and API07/011. SAF2016-76046-R and SAF2013-46292-R (MINECO and FEDER). The West London (UK) cohort was funded The Wellcome Trust (Grant Number: 042025; 052247; 064607)