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Discriminating N-Methyl-D-Aspartate Receptor-antibody encephalitis (NMDAR-Ab-E) from primary psychosis

NMDAR-antibody encephalitis (NMDAR-Ab-E) is a condition in which the body mistakenly attacks a person’s NMDA receptors in the brain. These receptors are important in normal brain function including learning, memory, and normal conscious awareness. The antibodies reduce available receptors and so affect these functions. As the disease worsens breathing and heart function are affected meaning that some patients become critically unwell.  

People with NMDAR-Ab-E typically present with psychiatric symptoms and the symptoms can overlap with common severe mental illnesses. This makes diagnosis challenging and NMDAR-Ab-E is commonly misdiagnosed as a primary psychosis, delaying life-saving neurological treatments. Establishing which clinical features differentiate NMDAR-Ab-E from primary psychoses will improve diagnosis and care   for both groups.

The mental state examination (MSE) is a standardised clinical interview which forms part of the assessment of psychiatric and neurological disorders. We have looked at MSE data from a cohort of NMDAR-Ab-E positive patients and coded their symptoms using a standardised coding scheme. We now wish to collect the same data for patients presenting with a first episode of primary psychosis. To do this, we will extract mental state data such as symptoms and specific behaviours from case records of a psychosis early intervention service, using expert annotators to derive the information from free-text and code it using the same coding tool . The tool is a simple list of the features being present or absent and the level of confidence for that impression. We will then compare the two groups to determine which clinical features best discriminate between these diagnoses.

Diabetes in Mental Health

People living with diabetes need to manage their condition on everyday basis to stay well and avoid complications from diabetes. When they come in contact with mental health services, their mental health problems take priority and their needs related to diabetes (e.g. medication, diet, exercise) may be overlooked.

This is why it is important to explore if healthcare professionals in mental health services check if a patient has diabetes and if yes, if this information is used to support both mental health and physical health needs of the patient.

This study is the first step in answering this question and it aims to check if we can use information in the electronic health records to better understand what happens to patients who have diabetes on top of their mental illness (for example if treatment is altered, appropriate recommendations made).  

Rare side effects of psychotropics bone marrow toxicity and dysphagia

Some rare but potentially significant side effects such as a reduction in the number of blood cells that help fight infections or stop bleeding have been related to psychotropic medications; another significant side effect can be problems with swallowing. While these side effects are recognised with some medications, little is known about the frequency of these side effects. Here we will use the Oxford Health UK CRIS Database to identify people who are treated with medications such as mirtazapine (an antidepressant) and compare the frequency to another antidepressant such as sertraline. The UK CRIS allows for data on a large number of patients to be investigated and inferences to be made on the frequency of rare and life-threatening side effects of psychotropic medications. The results of this study could inform on management of risk and clinical monitoring and consequently, help to improve patient care.

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This is a prescribed app. It should only be used alongside a face to face intervention provided by a mental health worker. Check with your local service to see if they subscribe to the app.