Virtual reality-based cognitive-behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction:a randomised clinical trial

Background The presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction(AMI),significantly disrupting their recovery.Providing timely and easily accessible psychological interventions using virtual reality-based cognitive-behavioural therapy(VR-CBT)could potentially improve both acute and long-term symptoms affecting their mental health.Aims We aim to examine the effectiveness of VR-CBT on anxiety symptoms in patients with AMI who were admitted to the intensive care unit(ICU)during the acute stage of their illness.Methods In this single-blind randomised clinical trial,participants with anxiety symptoms who were admitted to the ICU due to AMI were continuously recruited from December 2022 to February 2023.Patients who were Han Chinese aged 18-75 years were randomly assigned(1:1)via block randomisation to either the VR-CBT group to receive VR-CBT in addition to standard mental health support,or the control group to receive standard mental health support only.VR-CBT consisted of four modules and was delivered at the bedside over a 1-week period.Assessments were done at baseline,immediately after treatment and at 3-month follow-up.The intention-to-treat analysis began in June 2023.The primary outcome measure was the changes in anxiety symptoms as assessed by the Hamilton Anxiety Rating Scale(HAM-A).Results Among 148 randomised participants,70 were assigned to the VR-CBT group and 78 to the control group.The 1-week VR-CBT intervention plus standard mental health support significantly reduced the anxiety symptoms compared with standard mental health support alone in terms of HAM-A scores at both post intervention(Cohen’s d=−1.27(95%confidence interval(CI):−1.64 to−0.90,p<0.001)and 3-month follow-up(Cohen’s d=−0.37(95%CI:−0.72 to−0.01,p=0.024).Of the 70 participants who received VR-CBT,62(88.6%)completed the entire intervention.Cybersickness was the main reported adverse event(n=5).Conclusions Our results indicate that VR-CBT can significantly reduce post-AMI anxiety at the acute stage of the illness;the improvement was maintained at the 3-month follow-up.Trial registration number The trial was registered at www.chictr.org.cn with the identifier:ChiCTR2200066435.

Research on the Intervention Effect of Vibroacoustic Therapy in the Treatment of Patients with Depression

Research purpose:This study implemented somatosensory music therapy on patients with depressive disorders,and explored the effects of somatosensory music therapy on the degree of depression,positive and negative emotions,intuitive stress and autonomic nervous function of patients.Research method:We collected 66 patients diagnosed with depression from the Department of Psychological Medicine of Henan Provincial People’s Hospital,and divided them into a control group and an intervention group according to the random number table,with 33 people in each group.The control group received routine psychiatric treatment and nursing.On the basis of the control group,the intervention group received somatosensory music therapy 3 times a week,30 min each time,for 4 consecutive weeks.The Hamilton Depression Scale,Positive and Negative Emotion Scale,Perceived Stress Scale,and Heart Rate Variability Index were collected and analyzed at baseline(T0),2 weeks after treatment(T1)and 4 weeks after treatment(T2).Research results:After 4 weeks of treatment,the HAMD scores of the two groups decreased to varying degrees,and the difference between the groups was statistically significant(p<0.05).After 4 weeks of treatment,the scores of positive emotions in both groups increased to varying degrees,and the scores of negative emotions increased to varying degrees.The scores decreased to varying degrees,and there were statistically significant differences between the positive and negative emotion groups(p<0.05).After 4 weeks of treatment,the CPSS scores of the two groups decreased to varying degrees,and the difference between the two groups was statistically significant(p<0.05).Analyzing the main effect of intervention factors alone,after 4 weeks of treatment,SDNN and RMSSD indexes all increased to varying degrees,and the degree of increase in the intervention group was greater than that in the control group,and the difference between the groups was statistically significant(p<0.05).Research conclusion:assisting somatosensory music therapy for patients with depressive disorders can improve depressive symptoms,increase positive emotions,reduce negative emotions,and reduce perceived stress.These are beneficial to restore the balance of autonomic nervous system,and are effective for the treatment of depression.

Is it possible to run after positive affective experiences instead of health benefits without tackling social inequalities?

We recently read the opinion piece titled“Why people should run after positive affective experiences instead of health benefits”,which was carried out by Maltagliati et al.^(1)and published in the Journal of Sport and Health Science.The article started an important discussion about a physical activity(PA)promotion approach that encourages the use of affective experience to PA activity.Although we agree with the authors’point of view and believe that its message can generate an important insight for PA promotion,the authors presented a scenario where behavior change seems to be exclusively dependent on the individual.Recognizing the existence of other barriers to an active lifestyle(e.g.,social inequalities)could enhance the authors’suggested approach because many people live in conditions that reduce their opportunities to engage in affective experiences related to PA;furthermore,affective experiences can vary depending on individual context.

Improving the Appropriateness of Antipsychotic Prescribing for Behavioral and Psychological Symptoms of Dementia (BPSD): A Pilot Study of the Psychotropic Use Monitoring (PUM) Program

In nursing homes, antipsychotic prescribing decisions (APDs) for managing behavioral and psychological symptoms of dementia (BPSD) depend on the nursing staff’s feedback. Inappropriate APDs can result in the lack of timeliness, objectivity and important clinical information when nursing staff’s feedback on residents’ behavior and pharmacotherapy outcomes. Currently, there are no reported interventions for improving psychiatrists’ APDs through nursing staff’s monitoring and feedback processes. This one-group pre-and-post pilot study aimed to evaluate the feasibility and impact of implementing a newly-developed Psychotropic Use Monitoring (PUM) program for improving the appropriateness of APDs in a 50-bed dementia ward of a nursing home. The PUM intervention involved 16 pharmacist-trained nursing staff, who monitored and reported residents’ BPSD changes and psychotropic side effects for 24 weeks, while carrying out their routine care duties. A face-to-face interview was then administered to determine the nursing staff’s perceptions of PUM. Data of 51 residents were collected from hardcopy individual patient records to evaluate the changes in APDs and the number of resident falls before and after implementing PUM. The nursing staff reported increases in their knowledge, awareness, confidence, and actual frequency of monitoring for side effects, as well as their ability in differentiating and managing BPSD (p < 0.05). After PUM, there was a significant increase in the number of APDs due to side effect-related reasons (4 versus 16) (p < 0.031). Although not significant, the number of APDs with no documented reasons (5 versus 9) and the number of resident falls (7 versus 15) appeared to be lesser after PUM. This study demonstrated the nursing staff’s positive participation in PUM intervention, specifically in monitoring and feedback of side effects. Furthermore, a potential exists for PUM to encourage more judicious APDs, which may be useful in settings with heavy patient load, limited human resources and dependence on foreign nursing staff from differing cultural backgrounds.

Impulsivity-related right superior frontal gyrus as a biomarker of internet gaming disorder

Background Internet gaming disorder(IGD)is a mental health issue that affects individuals worldwide.However,the lack of knowledge about the biomarkers associated with the development of IGD has restricted the diagnosis and treatment of this disorder.Aims We aimed to reveal the biomarkers associated with the development of IGD through resting-state brain network analysis and provide clues for the diagnosis and treatment of IGD.Methods Twenty-six patients with IGD,23 excessive internet game users(EIUs)who recurrently played internet games but were not diagnosed with IGD and 29 healthy controls(HCs)performed delay discounting task(DDT)and Iowa gambling task(IGT).Resting-state functional magnetic resonance imaging(fMRI)data were also collected.Results Patients with IGD exhibited significantly lower hubness in the right medial orbital part of the superior frontal gyrus(ORBsupmed)than both the EIU and the HC groups.Additionally,the hubness of the right ORBsupmed was found to be positively correlated with the highest excessive internet gaming degree during the past year in the EIU group but not the IGD group;this might be the protective mechanism that prevents EIUs from becoming addicted to internet games.Moreover,the hubness of the right ORBsupmed was found to be related to the treatment outcome of patients with IGD,with higher hubness of this region indicating better recovery when undergoing forced abstinence.Further modelling analysis of the DDT and IGT showed that patients with IGD displayed higher impulsivity during the decision-making process,and impulsivity-related parameters were negatively correlated with the hubness of right ORBsupmed.Conclusions Our findings revealed that the impulsivity-related right ORBsupmed hubness could serve as a potential biomarker of IGD and provide clues for the diagnosis and treatment of IGD.

Usage of complementary and alternative medicine in older adults: prevalence, subtypes and associated factors;a cross-sectional observation

Background:The usage of complementary and alternative medicine(CAM)is common in many healthcare settings worldwide.However,the factors associated with CAM usage in older adults and its relation with mood and cognitive function is under-studied.We used a cross-sectional study to explore the 12-month prevalence of usage of CAM among older adults in Singapore and its associated factors including mental health status.Methods:Using a door-to-door census and questionnaire survey,community dwellers aged 60 or above were voluntarily recruited in the Singapore Longitudinal Aging Study.Demographic information,usage of CAM in past 12 months,life-style,cognitive and depressive status using Mini-Mental Status Examination and Geriatric Depression Scale were collated from each participant.Results:Out of 4985 participants,2692(54%)used some types of CAM.The most common type of CAM was herbal medicine,followed by Qigong and Acupuncture.The usage of CAM was higher in Chinese females and those with higher educational levels.Having a history of chronic diseases was associated with higher prevalence of CAM use.Usage of CAM was also correlated with higher physical and social activities.No correlation was observed between cognitive or depressive status and the use of CAM.Conclusion:These results show a high prevalence of CAM usage among older adults in Singapore,which should be considered by medical practitioners treating this age group.Additionally,despite higher prevalence of suffering from multiple chronic diseases,the lack of association of CAM usage with poorer performance in mood and cognitive assessments suggests a protective role against depression and cognitive decline for CAM practices.

Protocol for the development of clinical guidelines for the management of chronic primary pain

Introduction Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.In 2018,the World Health Organization(WHO)revised the International Classification of Diseases,11th Revision(ICD-11)to include chronic pain as an independent disease for the first time(MG30.0).1 At the same time,the ICD-11 also developed new classifications for chronic pain,including chronic primary pain(CPP),chronic cancer-related pain,chronic post-surgical or post-traumatic pain,chronic secondary musculoskeletal pain,chronic secondary visceral pain.

Psychological Issues among Women Undergoing Fertility Treatment in a Specialist Fertility Hospital, South East Nigeria

Introduction: In Nigeria, a major reason for marriage is procreation and married couples look forward to having children within a year or two of marriage. The inability to achieve conception and subsequently have a child among couples may lead to psychological complications. Objective: This study assessed the psychological impact of infertility and its management on women receiving treatment at a Fertility Specialist Hospital in a poor resource setting. Methods: This was a cross-sectional study of 376 consenting married women who sought and received fertility treatment at a private Fertility Specialist Hospital, located at Abakaliki, South-East Nigeria between May 1, 2017 and May 31, 2022. Socio-demographic and Structured questionnaires were administered to the participants over a 5-year period. Results: The mean age of the women at presentation was 36.9 (±7.2 SD) years. The majority of the women (227) presented with secondary infertility accounting for 60.4%, while the rest had primary infertility (χ2 = 16.18, P = 0.001). Male-only factor infertility accounted for 22.9% of all the infertility cases, female-only factor 21.3% while both (male and female factors co-existing) accounted for 52.7% of all the cases. The commonest cause of infertility in the study was poor sperm parameters (176) accounting for 46.8% of cases, tubal factor 19.1% and anovulatory factor 22.3% (χ2 = 214.21, P = 0.001). Three hundred and thirty four (88.8%) felt depressed, 266 (70.7%) felt guilty about the past, and 222 (59.0%) had suicidal tendencies because of the infertility ordeal. Two hundred and fifty one (66.8%) felt inferior, 237 (63.0%) cried often and 174 (46.3%) were socially withdrawn. However, 10.4% of the women felt satisfied and well. These negative psychological feelings were statistically significant. Concerning the effect on marriage, the closeness of couples was reduced significantly in 57.7%, 62.8% had reduced coital intimacy, 79.3% had frequent quarrel and misunderstanding, 27.9% had threats of divorce while 4.5% had actually divorced and 11.% separated. However, there was no negative effect of infertility in 8.8% of couples. Conclusion: Psychological issues associated with infertility and its management in women include feelings of depression, guilt feelings, suicidal ideation, weeping episodes, social withdrawal, feelings of inferiority, reduced libido, and poverty of intimacy with frequent quarrels and misunderstanding. Women appear to bear more of the psychological issues associated with infertility. Early marriage on the part of the women, preservation of their reproductive youthful ages, and a better understanding of the concept of infertility by the couple will not only reduce the prevalence of infertility but will also reduce the dangerous psychological issues associated with infertility.

The Status and Associated Factors of Successful Aging among Older Adults Residing in Longevity Areas in China

Objective This study aims to assess the status of successful aging （SA） in longevity areas in China and explore multiple factors associated with SA among the young-old and oldest-old. Methods A total of 2296 elderly people aged 65 and older were interviewed in the longevity areas sub-sample of the Chinese Longitudinal Healthy Longevity Survey （CLHLS） in 2012. Baseline assessments included a researcher-administered questionnaire, physical examination, and laboratory testing. A logistic regression model was used to identify factors associated with SA. Results The prevalence of SA was 38.81% in the CLHLS in 2012. There were significant differences between ages groups, with SA compromising 56.85% among _〉65 years group and 20.31% among 〉100 years group （X2trend=126.73, P〈O.01）. The prevalence of SA among females was 33.59%, which was significantly lower than that among males （45.58%） （X2gender=33.65, P〈0.05）. In the regression analysis, having anemia ~OR=0.744, 95% CI： 0.609-0.910）, poor lifestyle （OR=0.697, 95% CI： 0.568-0.854）, poor sleep quality （OR=0.558, 95% CI： 0.456-0.682）, and central obesity （OR=0.684, 95% CI： 0.556-0.841） were the main factors associated with SA. The promoting SA rate decreased as age increased, and the group of 65-79 years had higher odds than the other age group. Conclusion Preventing central obesity, improving sleep quality and promoting healthy lifestyle may contribute to achieve SA among the elderly.

Serotonin regulates brain-derived neurotrophic factor expression in select brain regions during acute psychological stress

Previous studies suggest that serotonin （5-HT） might interact with brain-derived neurotrophic factor （BDNF） during the stress response. However, the relationship between 5-HT and BDNF expression under purely psychological stress is unclear. In this study, one hour before psychological stress exposure, the 5-HT1A receptor agonist 8-OH-DPAT or antagonist MDL73005, or the 5-HT2A receptor agonist DOI or antagonist ketanserin were administered to rats exposed to psychological stress. Immunohistochemistry and in situ hybridization revealed that after psychological stress, with the exception of the ventral tegmental area, BDNF protein and mRNA expression levels were higher in the 5-HT1A and the 5-HT2A receptor agonist groups compared with the solvent control no-stress or psychological stress group in the CA1 and CA3 of the hippocampus, prefrontal cortex, central amygdaloid nucleus, dorsomedial hypothalamic nucleus, dentate gyrus, shell of the nucleus accumbens and the midbrain periaqueductal gray. There was no significant difference between the two agonist groups. In contrast, after stress exposure, BDNF protein and mRNA expression levels were lower in the 5-HT1A and 5-HT2A receptor antagonist groups than in the solvent control non-stress group, with the exception of the ventral tegmental area. Our findings suggest that 5-HT regulates BDNF expression in a rat model of acute psychological stress.

Systematic review of suicide in economic recession

AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide.METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycI NFO and PsycA RTICLES was performed to identify studies that had investigated the association between economic recession and suicide. RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive. CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.

Testing a hypothesis arising from the epidemiology of schizophrenia in New Zealand

A 2011 publication in World Psychiatry thoughtfully, but somewhat pessimistically, addressed the question of how schizophrenia might be prevented.1 A review of causal evidence2 a decade later offers little further hope. We hypothesise that an emergent increase in syndromal schizophrenia in New Zealand, particularly in Maori (descendants of the indigenous Polynesian population), may present opportunities for prevention.

Electroconvulsive Therapy in the Eyes of Undergraduate Nursing Students

Despite the fact that electroconvulsive therapy (ECT) is an established safe and effective procedure, its use has continued to attract controversy with considerable stigma associated with it. This often overshadows the established effectiveness. Poor knowledge, negative attitude and bias towards ECT by the nurses may translate to poor education and support to patients from whom they are expected to obtain informed consent before an ECT procedure. This study assessed the perception of undergraduate nursing students of a Nigerian university about ECT. A total of 81 students who had completed all relevant lectures and practical/clinical exposures in psychiatry as prescribed in their academic curricular participated in the study. All the consenting students were administered the socio-demographic questionnaire and modified questionnaire on attitude and knowledge of electroconvulsive therapy (QuAKE). Majority of the students responded appropriately to the principal uses of ECT. Few believed that ECT was an out-moded form of treatment, that the procedure was cruel and barbaric, that psychiatrists who still administered ECT were wicked and not responsible physicians, and that it caused permanent brain damage. The total mean score of the students was 7.53 ± 2.65. Fifty eight (71.6%) students observed an ECT procedure and followed up the patients during the posting. They scored 7.17 ± 2.55 while 23 (28.4%) students who had not observed the procedure scored 6.98 ± 1.92 on the QuAKE (t =?-0.36, p = 0.72). Thirty one (38.3%) students who would accept the procedure if indicated scored 7.14 ± 2.21 while 50 (61.7%) of them who would not allow ECT carried out on them scored 6.88 ± 1.96 (t = 0.56, p = 0.58). The mean score of 29 (35.8%) students who might pursue psychiatry as a career was 8.10 ± 1.90 while 52 (64.2%) of them who would not specialise in psychiatry scored 6.05 ± 1.79 (t = 5.00, p < 0.001). The total mean score on the QuAKE was low among the student nurses. Therefore, there is a need to improve undergraduate nursing education on ECT.

The Stigma of Epilepsy among Outpatients in a Tertiary Hospital in South-East Nigeria

Background: The stigma of epilepsy is pervasive in developing country contexts and negatively affects the psychological and social wellbeing of its sufferers. The experience of stigma varies across settings and probably relate to disease severity and social characteristics. This study sought to describe the extent and correlates of perceived and enacted stigma among outpatients with epilepsy. Methods: The participants were consecutively presenting epilepsy outpatients in a tertiary facility that attended clinic regularly and had no overt medical or psychiatric co-morbidities. The patients were interviewed with a semi-structured questionnaire. Results: There were 93 participants with a mean age of 30.2 ± 10.3 years and 57.0% were males. The experience of stigma was reported by 46.2% and 67.7% of the participants for perceived and enacted stigma, respectively. Over one-third of the patients had suffered burns or a similar injury in the past. The correlates of perceived stigma were rural residence, lower levels of education, and longer duration of illness. Gender, age and frequency of seizures were not statistically significant determinants. The correlates of enacted stigma were being single, older age, rural residence, and longer duration of epilepsy. A past history of burns and disclosure of epilepsy to individuals outside the family added to the likelihood of experiencing stigma. Conclusion: The burden of epilepsy related social stigma is high in Nigeria. Cultural stereotypes and misconception add to this. There is need for appropriate culture-congruent educational interventions to provide the right information about epilepsy and debunk the misconceptions and myths associated with the condition. This will need to be coupled with astute clinical management of cases and active case finding. Both qualitative and longitudinal quantitative studies would be required to deepen our understanding of the lived reality of grappling with stigma in our setting.

“Goals Give You Hope”:An Exploration of Goal Setting in Young People Experiencing Mental Health Challenges

The mental health of New Zealand’s adolescents is,by global standards,remarkably poor.Addressing such mental health needs is not only pertinent with regards to the quality of life of our young people,but also the health of our society as a whole,with current unmet youth mental health needs becoming future adult population health def-icits.While an array of evidence-based psychotherapies are available as treatment,our knowledge of the mechan-ism of actions underlying each of these is lacking.We propose that the practice of goal setting as a therapeutic technique may represent not only a common element across these therapies,but may also significantly contribute to their relative efficacies.Developing a fuller understanding of goal setting’s usefulness and efficacy,as perceived by youth with mental health difficulties,may serve to aid in the development and deployment of more effective interventions,providing a small stepping-stone on the path towards addressing our current youth mental health crisis.Through a series of semi-structured interviews with nine young people aged 16–24 years old in New Zeal-and,we strive to create a nuanced understanding of young people’s perception and use of goal setting,and its potential significance both within and beyond the realm of psychotherapy.Key themes derived from the data include(1)motivation for goal setting and achieving;(2)barriers to goal setting and achieving;(3)strategies for goal achievement;(4)the role of self-efficacy;(5)the role of support;and(6)benefits of goal setting.Thefind-ings generated from this study suggest that goal setting as a therapeutic technique,when used appropriately,can have significant positive impacts on the emotional state,productivity,and view of the future for young people experiencing mental health challenges.

Beliefs and Clinical Practice for Complex Regional Pain Syndrome (CRPS) Managed by Physiotherapists on the South Island of New Zealand

On the South Island of New Zealand, Anaesthetists and other Medical Professionals, frequently refer their patients with Complex Regional Pain Syndrome (CRPS) for physiotherapy management. Beliefs about what is important for the management of patients with CRPS are lacking across all medical and allied health disciplines. Difficulties are no gold standard for diagnosis and evidence for intervention methods is moderate or can be conflicting. This paper explores what Physiotherapists believe to be important in a clinical setting for their management of CRPS, as well as documenting and evaluating their interventional methods used in everyday clinical practice across the region of the South Island of New Zealand. This has not been recorded before. Eighty-one Physiotherapists replied to questions on their usual treatment interventions for the management of CRPS, their frequency of use of these treatment interventions, and what they believed to be important in the management of pain and improvement of function. The results demonstrated that CRPS is not a common condition seen regularly by Physiotherapists;that there is a high level of variation between the physiotherapy interventions used and that Physiotherapists’ beliefs regarding interventions used for pain management and functional restoration differ. Education was reported as the most frequently used intervention method. Those physiotherapists seeing CRPS patients more frequently are more likely to use evidence based intervention methods like graded motor imagery or sensory motor training.

Systematic review of evidence for different treatment settings in anorexia nervosa

AIM: To compare outcomes in anorexia nervosa(AN) in different treatment settings: inpatient, partial hospitalization and outpatient. METHODS: Completed and published in the English language, randomized controlled trials comparing treatment in two or more settings or comparing different lengths of inpatient stay, were identified by database searches using terms "anorexia nervosa" and "treatment" dated to July 2014. Trials were assessed for risk of bias and quality according to the Cochrane handbook by two authors(Madden S and Hay P) Data were extracted on trial quality, participant features and setting, main outcomes and attrition. RESULTS: Five studies were identified, two comparing inpatient treatment to outpatient treatment, one study comparing different lengths of inpatient treatment, one comparing inpatient treatment to day patient treatment and one comparing day patient treatment with outpatient treatment. There was no difference in treatment outcomes between the different treatment settings and different lengths of inpatient treatment. Both outpatient treatment and day patient treatment were significantly cheaper than inpatient treatment. Brief inpatient treatment followed by evidence based outpatient care was also cheaper than prolonged inpatient care for weight normalization also followed by evidence based outpatient care. CONCLUSION: There is preliminary support for AN treatment in less restrictive settings but more research is needed to identify the optimum treatment setting for anorexia nervosa.

Acceptability and Feasibility of YouthCHAT to Detect Psychosocial Problems in Young People with Congenital Heart Disease

Objective:Young people with congenital heart disease(CHD)are at increased risk of psychosocial issues,includ-ing anxiety and depression that can affect their medical care and quality of life.This open trial investigated the acceptability,feasibility and preliminary effectiveness of YouthCHAT,a tablet-based screener,designed to identify similar issues to a face to face psychosocial assessment,with young people who have CHD.Methods:Youth-CHAT was administered to 44 such young people aged 15–25 years attending a specialist outpatient clinic at a New Zealand tertiary hospital.Key outcomes were(i)acceptability and(ii)feasibility of YouthCHAT,assessed via feedback from young people and clinicians and(iii)detection rates for each domain of YouthCHAT,measured by mental health or lifestyle issue being‘present’or‘absent’.Results:YouthCHAT was quick to complete(mean 9 min and 7 s)and well-received by young people(overall rating 7 out of 10)and clinicians.Rates of anxiety,substance use and other issues were similar to those in a previous study of young people with mixed long-term physical conditions.However,rates of depression(41%)and life stresses(98%)were notably higher.Conclusions:Although further research is required,our results provide initial evidence that YouthCHAT is a viable and accep-table psychosocial screener with which to improve the holistic care of young people with CHD.

Management of a Cluster of Foreign Body Ingestion Incidents in Patients with Borderline Personality Disorder

Objective: Deliberate foreign body ingestion (DFBI) has been reported in patients with personality disorders as part of a spectrum of self-harming behaviours, however the published literature is small (15 case reports). Method: This was a retrospective audit of medical and psychological management of a cluster of 12 DFBI incidents over 9 months in 4 young female patients with Borderline Personality Disorder (BPD). Results: All four patients knew one another from outpatient psychotherapy programmes. DFBI was associated with substance use in 5/12 incidents, and with precipitants (experiencing strong emotions, witnessing self-harm) in 4/12 incidents. Most DFBI involved sharp objects (razor blades, glass, safety pins). Medical intervention was initially active (endoscopy/surgery) but progressed to a more conservative, observational approach. Psychological management was initially restrictive, but also changed over time to focus on identifying distress, enhancing coping mechanisms and patient responsibility. Co-ordination of patient care management involvedintensive liaison (provision of interdisciplinary support and education) between medical, surgical and psychiatric teams. Conclusion: Management of DFBI in patients with BPD requires high levels of interdisciplinary collaboration. In this cluster of DFBI incidents, effective management was achieved with conservative medical/surgical methods (observation) and non-restrictive psychological approaches that enhanced patient self-efficacy.