The Headscarf Effect Revisited:Further Evidence for a Culture-Based Internal Face Processing Advantage

© 2015 a Pion publication. Encoding the internal features of unfamiliar faces poses a perceptual challenge that occasionally results in face recognition errors. Extensive experience with faces framed by a headscarf may, however, enhance perceivers’ ability to process internal facial information. To examine this claim empirically, participants in the United Arab Emirates and the United States of America completed a standard part-whole face recognition task. Accuracy on the task was examined using a 2 (perceiver culture: Emirati vs American) × 2 (face race: Arab vs white) × 2 (probe type: part vs whole) × 3 (probe feature: eyes vs nose vs mouth) mixed-measures analysis of variance. As predicted, Emiratis outperformed Americans on the administered task. Although their recognition advantage occurred regardless of probe type, it was most pronounced for Arab faces and for trials that captured the processing of nose or mouth information. The findings demonstrate that culture-based experiences hone perceivers’ face processing skills

The headscarf effect revisited: Further evidence for a culture-based internal face processing advantage

© 2015 a Pion publication. Encoding the internal features of unfamiliar faces poses a perceptual challenge that occasionally results in face recognition errors. Extensive experience with faces framed by a headscarf may, however, enhance perceivers’ ability to process internal facial information. To examine this claim empirically, participants in the United Arab Emirates and the United States of America completed a standard part-whole face recognition task. Accuracy on the task was examined using a 2 (perceiver culture: Emirati vs American) × 2 (face race: Arab vs white) × 2 (probe type: part vs whole) × 3 (probe feature: eyes vs nose vs mouth) mixed-measures analysis of variance. As predicted, Emiratis outperformed Americans on the administered task. Although their recognition advantage occurred regardless of probe type, it was most pronounced for Arab faces and for trials that captured the processing of nose or mouth information. The findings demonstrate that culture-based experiences hone perceivers’ face processing skills

DOES EARLY INTERVENTION FOR PSYCHOSIS WORK? An analysis of Outcomes of Early Intervention in Psychosis based on the Critical Period Hypothesis, Measured by Number of Admissions and Bed Days Used over a period of Six Years, the first three in an Early Intervention Service, The second Three in a Community Mental Health Team

Background: Early Intervention in Psychosis (EI) was introduced into the British NHS as a result of the NHS Plan, about eleven years ago. The intention was to provide thebest possible care or patients with a first episode of psychosis.Recently however, long term studies over five years have suggested that early gains may be lost. Methods and Aims: We wished to establish whether our own group of patients who had received Early Intervention continued over six years to have better outcomes than patients treated in Community Mental Health Teams. To do this we analysed statistically the data on the readmissions and bed days used by our patients over the first six years of illness. Results: We found that patients, both in the whole two groups and in different sub-groups appeared to demonstrate a number of advantages,not always statistically significant, in favour of the EI treated team. Discussion: In many cases, the small size of the samples may have impeded us observing statistically significant differences, however, in general, it appeared that there were a number of advantages in favour of the EI treated team. Conclusion: Our study, though small, does appear to support the view that Early Intervention Services do improve outcomes and that some of the improvement may endure after the patient leaves EI services. Much larger studies ae however required

ASSESSMENT OF SELF HARM IN AN ACCIDENT AND EMERGENCY SERVICE - THE DEVELOPMENT OF A PROFORMA TO ASSESS SUICIDE INTENT AND MENTAL STATE IN THOSE PRESENTING TO THE EMERGENCY DEPARTMENT WITH SELF HARM

Introduction: The UK has one of the highest rates of self harm in Europe, around 400 per 100,000 people (Horrocks et al. 2002). It accounts for 150,000 attendances to the Emergency department each year and is one of the top five causes of acute medical admissions in the UK (NICE 2002). Aims: Objectives included to explore the method of self harm and the demographic factors of those presenting the Emergency department with self harm. In addition we wanted to review the exploration of suicide risk factors and suicide intent by the Emergency department doctor and ascertain whether a psychiatric assessment with full mental state examination had been conducted with referral to psychiatric services if deemed necessary. We wanted to explore the current practice around self harm presentations in the Emergency department accordance with NICE guidelines. Methods: Data was collected retrospectively from February to August 2009. Twenty-five sets of medical notes were collated at random for patients who had presented with self harm to the Emergency department. Notes were reviewed for evidence of exploration of the event, psychiatric assessment, risk factors for suicide and further referral. Results: 14 of the 25 patients presented having taken an overdose. 9 had inflicted some other form of self injury, namely lacerations to self. In 2 cases a mixed presentation was found. Previous psychiatric history was documented in 16 cases. 11 had a previous history of depression or anxiety disorder; 1 was known to have bipolar affective disorder; 1 was diagnosed in the past with borderline personality disorder; and 3 patients had no previous history. In 9 cases previous history was not documented. Discussion: Twenty-five sets of medical notes were reviewed from February to August 2009 for individuals presenting to the Emergency department with self harm. Of those, 12 fell into the over 25 age group. 17 were female and 8 were male. The majority of patients were of white British ethnicity. 14 had taken an overdose; 9 had inflicted some other form of self injury; and 2 had a mixed presentation. Suicide risk factors and suicidal intent was poorly documented with mental state examination found not to be documented in all 25 cases reviewed. 18 were deemed medically fit in the Emergency department and were referred for psychiatric review. These unfortunate findings may be a reflection on the time pressures faced by Emergency department doctors, namely the four hour targets, and perhaps lack of adequate training in psychosocial risk assessment. With such poor documentation made by the Emergency department doctors, a proforma was produced which incorporates suicide risk factors and assessment of suicide intent in addition to a brief version of the mental state examination. Conclusion: Concerns have been raised by the recent Royal College of Psychiatrists report on self harm, that current level of care provided to service users fall short of the standards set out in policies and guidelines, with poor assessments, unskilled staff and insufficient care pathways (Royal College of Psychiatrists. Report CR 158. 2010). Indeed evidence suggest that appropriate training and intervention given to A&E staff can lead to improvements in the quality of psychosocial assessment of patients with deliberate self harm (Crawford et al. 1998)

MENTAL HEALTH ASSESSMENT UNIT AUDIT

Introduction: The Mental Health Assessment Unit (MHAU) is a unit set up in 2009 as a gateway between community services and in-patient services. The aim of the MHAU is to provide an acute setting in which to assess patients within 72 hours, with the view to reducing in-patient hospital admissions. Aim: To ascertain the number of referrals made to the MHAU and admissions during a one month period. The presentation and length of stay was investigated and the diagnosis and follow up plans made were explored. Method: Data was collated from a one month period, from the 1st June to 2nd July 2010 inclusive. Crisis and home treatment team (CRHT) notes, medical notes and nursing notes were reviewed. Results: 100 referrals were made to the MHAU; 48 patients were admitted. 25 patients had care coordinators. Despite this, in the majority of cases the source of referral was through the Emergency Department. There was a range of presenting complaints ranged and diagnoses included a wide variety of nature and severity. Average length of stay was 2 nights. Patients deemed to require in-patient management had shorter length of stay with swift transfer to treatment units. Shorter stays were also associated with milder degrees of illness. Longer length of stay was associated with more complex illness. 37 patients were discharged home from the MHAU, 8 were transferred to in-patient treatment units and 3 were transferred to in-patient units elsewhere. The majority of patients discharged home were followed up by the CRHT. 5 patients were admitted to the MHAU more than once. 4 were admitted twice, and one was admitted three times. 4 of these patients were discharged home but one was admitted to in-patient unit on his second admission. This may represent a subgroup of more complex patients. Conclusion: We recommend further study into patients\u27 experiences with care coordinators particularly at times of need. We also plan to re-audit for a longer time frame with the view to compare data to in-patient admissions and bed occupancy

SCREENING FOR DEPRESSION IN POST STROKE PATIENTS

Background: Depression has a significant prevalence in patients following a stroke. Studies have found rates to be between 25- 54%. Aims: Within this audit we aimed to ascertain the proportion of patients who have been identified as having depression, and explore the methods employed to identify depressed patients. We also looked to assess the number of these patients who have been treated for depression and to explore the medications used for the treatment of depression. Methods: This audit was conducted in two phases. Initially an audit was conducted to establish the current prevalence, screening and management of depression in post-stroke patients. Following this, we introduced the PHQ-9 as a screening tool for depression and a re-audited at four months. In phase 2, All patients admitted to the stoke ward in Bedford hospital between 10/9/09 and 13/12/09 were included in the audit. Patients were screened for depression using the PHQ-9 questionnaire two weeks after admission. Results: The incidence of depression within the phase one group was 28%. In 9 of these cases there was no record of mood assessment or diagnosis of depression in the medical notes. Thirteen out of 60 patients were prescribed psychotropic agents during their stay. In phase 2, Of the 18 patients screened, 10 patients (56%) scored 5 or above, which according to the scoring system of the PHQ-9 is indicative of depression. One patient scored 10 indicative of moderate depression and one patient scored 19 indicative of moderately severe depression. Discussion: Phase 1 of this audit revealed that there was no formal screening tool in use to identify depression in post stroke patients. Consequently we found the prevalence to be 28%. This correlates with the lower end of the rate expected within this group according to the literature. As no screening tool was being used, practice was not in accordance with the standards set by NICE guidelines. This led us to introduce the PHQ-9 screening tool in phase 2. Following this, we found the prevalence of depression had increased from 28% to 56%. Conclusions: These results highlight the importance of formal screening in order to reliably identify patients who have signs of depressio

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population