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Fatema Ahmed Ali,1 Ghufran Jassim,2 Zahra Khalaf,3 Manaf Yusuf,4 Sara Ali,5 Nada Husain,6 Fatema Ebrahim6 1Department of Internal Medicine, South West Acute Hospital, Western Health and Social Care Trust, Enniskillen, Northern Ireland, UK; 2Family Medicine Department, Royal College of Surgeons in Ireland — Medical University of Bahrain (RCSI Bahrain), Busaiteen, Kingdom of Bahrain; 3Department of Postgraduate Studies, Royal College of Surgeons in Ireland, Dublin, Ireland; 4Children’s & Adolescent Services, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK; 5Ministry of Health Bahrain, COVID-19 National Team, Sanabis, Kingdom of Bahrain; 6Department of Internal Medicine, Private Health Sector, Manama, Kingdom of BahrainCorrespondence: Ghufran Jassim, Family Medicine Department, Royal College of Surgeons in Ireland — Medical University of Bahrain (RCSI Bahrain), Busaiteen, Kingdom of Bahrain, Email gjassim@rcsi-mub.comObjective: This study aims to explore the prevalence of anosmia and dysgeusia and their impact on COVID-19 patients.Methods: This is a cross-sectional study. Patients diagnosed with COVID-19 between 1st October 2020 and 30th June 2021 were randomly selected from a national COVID-19 registry. COVID-19 cases were diagnosed using molecular testing method which measured the viral E gene. The Anosmia Reporting Tool, and a brief version of the questionnaire on olfactory disorders were used to measure the outcomes via telephone interviews. Data were analysed using SPSS 27 statistics software.Results: A total of 405 COVID-19 adults were included in this study, 220 (54.3%) were males and 185 (45.8%) were females. The mean±SD age of participants was 38.2 ± 11.3 years. Alterations in the sense of smell and taste were reported by 206 (50.9%), and 195 (48.1%) of the patients, respectively. Sex and nationality of participants were significantly associated with anosmia and dysgeusia (p < 0.001) and (p-value=0.001) respectively. Among patients who experienced anosmia and dysgeusia, alterations in eating habits (64.2%), impact on mental wellbeing (38.9%), concerns that the alterations were permanent (35.4%), and physical implications and difficulty performing activities of daily living (34%) were reported.Conclusion: Anosmia and dysgeusia are prevalent symptoms of COVID-19 disease, especially among females. Although transient, anosmia and dysgeusia had considerable impact on patient’s life. Neuropsychological implications of COVID-19 in acute infection phase and prognosis of anosmia and dysgeusia in COVID-19 are areas for further exploration.Keywords: anosmia, taste, smell, COVID-19, dysgeusia, quality of life

Shanaya Rathod,1 Lina Gega,2 Amy Degnan,3 Jennifer Pikard,4 Tasneem Khan,5 Nusrat Husain,3 Tariq Munshi,4 Farooq Naeem4 1Southern Health NHS Foundation Trust, Southampton, UK; 2Department of Health Sciences, University of York, York, UK; 3Division of Psychology and Mental Health, University of Manchester, Manchester, UK; 4Department of Psychiatry, Queen’s University, Kingston, ON, Canada; 5Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada Abstract: In recent years, there has been a steadily increasing recognition of the need to improve the cultural competence of services and cultural adaptation of interventions so that every individual can benefit from evidence-based care. There have been attempts at culturally adapting evidence-based interventions for mental health problems, and a few meta-analyses have been published in this area. This is, however, a much debated subject. Furthermore, there is a lack of a comprehensive review of meta-analyses and literature reviews that provide guidance to policy makers and clinicians. This review summarizes the current meta-analysis literature on culturally adapted interventions for mental health disorders to provide a succinct account of the current state of knowledge in this area, limitations, and guidance for the future research. Keywords: cultural adaptation, interventions, mental illness, meta-analysis, minority ethnic, psychotherapies

Francesca D Reeder,1 Nusrat Husain,2 Abdul Rhouma,3 Peter M Haddad,2 Tariq Munshi,4 Farooq Naeem,4 Davit Khachatryan,4 Imran B Chaudhry2 1School of Medicine, 2Neurosciences and Psychiatry Unit, University of Manchester, Manchester, 3Early Intervention Service, Lancashire Care NHS Foundation Trust, Preston, UK; 4Queen’s University, Kingston, Ontario, Canada Aim: There is evidence that childhood trauma is a risk factor for the development of psychosis and it is recommended that childhood trauma is inquired about in all patients presenting with psychosis. This study aimed to determine the prevalence of childhood trauma in patients in the UK Early Intervention Service based on a case note review.Methods: This is a retrospective case note study of 296 patients in an UK Early Intervention Service. Trauma history obtained on service entry was reviewed and trauma experienced categorized. Results were analyzed using crosstab and frequency analysis.Results: The mean age of the sample was 24 years, 70% were male, 66% were White, and 23% Asian (ethnicity not documented in 11% of the sample). Approximately 60% of patients reported childhood trauma, 21% reported no childhood trauma, and data were not recorded for the remaining 19%. Among those reporting trauma, the prevalence of most frequently reported traumas were: severe or repeated disruption (21%), parental mental illness (19%), bullying (18%), absence of a parent (13%), and ‘other’ trauma (24%) – the majority of which were victimization events. Sixty-six percent of those reporting trauma had experienced multiple forms of trauma.Conclusion: A high prevalence of childhood trauma (particularly trauma related to the home environment or family unit) was reported. This is consistent with other studies reporting on trauma and psychosis. The main weakness of the study is a lack of a control group reporting experience of childhood trauma in those without psychosis. Guidelines recommend that all patients with psychosis are asked about childhood trauma; but in 19% of our sample there was no documentation that this had been done indicating the need for improvement in assessment. Keywords: childhood trauma, psychosis, abuse, bullying, family

Usman Adam, Nusrat Husain, Peter M Haddad, Tariq Munshi, Fauzia Tariq, Farooq Naeem, Imran B ChaudhryBackground: Tardive dyskinesia (TD) is a side effect of antipsychotic treatment that often only appears after months or years of treatment. A systematic review of randomized controlled trials lasting more than 1 year showed that second-generation antipsychotics (SGAs) were associated with an approximately fivefold lower risk of TD compared to haloperidol in patients with chronic schizophrenia. In contrast, there is little research on the risk of TD with other first-generation antipsychotics (FGAs), and this applies especially to their use in the treatment of patients with first episode psychosis (FEP).Objectives: To determine the severity and point prevalence of TD in a naturalistic sample of patients with FEP in Pakistan treated with FGAs or SGAs.Methods: This was an observational study. TD was assessed by trained clinicians using the Abnormal Involuntary Movement Scale.Results: In the total sample (number =86) the mean age of patients was 26 years and the prevalence of TD (Schooler Kane criteria) was 29% with no significant difference between those treated with FGAs and SGAs (31% FGAs versus 26% SGAs; P=0.805). The Abnormal Involuntary Movement Scale total score (items 1–7), a measure of the severity of TD, was significantly higher for patients treated with FGAs versus those treated with SGAs (P=0.033). Scores on specific items showed that this reflected higher scores for dyskinesia affecting the muscles of facial expression, as well as of the upper and lower limb, whereas scores did not differ significantly in other body areas. Conclusion: FGAs were associated with greater severity, though not prevalence, of TD than SGAs. The study highlights the relatively high rate of TD in Asian FEP patients and the need for clinicians to monitor for this and other potential antipsychotic side effects during treatment. Keywords: first-generation antipsychotic, second-generation antipsychotic, Abnormal Involuntary Movement Scale

Primary extracranial meningiomas occur very rarely. We present a rare case of extracranial meningioma of the transitional variant which was excised satisfactorily. There was no suggestion of any connection to the intracranial compartment or cranial nerves. The underlying galea was uninvolved, suggesting the true extracranial nature of this tumour. This rare diagnosis should nonetheless be kept in the differential diagnosis of scalp tumors.

ObjectiveIncreasing evidence has shown that the risks associated with surgical revascularization for intermittent claudication outweigh the benefits. The aim of our study was to quantify the cost of care associated with perioperative complications after elective lower extremity bypass (LEB) in patients presenting with intermittent claudication.MethodsAll patients undergoing first-time LEB for claudication in the Healthcare Database (2009-2015) were included. The primary outcome was in-hospital postoperative complications, including major adverse limb events (MALE), major adverse cardiac events (MACE), acute kidney injury, and wound complications. The overall crude hospital costs are reported, and a generalized linear model with log link and inverse Gaussian distribution was used to calculate the predicted hospital costs for specific complications.ResultsOverall, 7154 patients had undergone elective LEB for claudication during the study period. The median age was 66 years (interquartile range, 59-73 years), 67.5% were male, and 75.3% were white. Two thirds of patients (61.2%) had Medicare insurance, followed by private insurance (26.9%), Medicaid (7.7%), and other insurance (4.2%). In-hospital complications occurred in 8.5% of patients, including acute kidney injury in 3.0%, MALE in 2.8%, wound complications in 2.3%, and MACE in 1.0%. The overall median crude hospital cost was $11,783 (interquartile range, $8911-$15,767) per patient. The incremental increase in cost associated with a postoperative complication was significant, ranging from $6183 (95% confidence interval, $4604-$7762) for MALE to $10,485 (95% confidence interval, $6529-$14,441) for MACE after risk adjustment.ConclusionsPostoperative complications after elective LEB for claudication are not uncommon and increase the in-hospital costs by 46% to 78% depending on the complication. Surgical revascularization for claudication should be used sparingly in carefully selected patients.

Background: Suicide is a major public health concern and one of the leading causes of mortality worldwide. People with an at‐risk‐mental‐state (ARMS) for psychosis are more vulnerable to psychiatric co‐morbidity and suicide, however, there are limited data from low‐middle‐income countries. The present study aimed to identify the prevalence of depressive symptoms and suicidal ideation along with sociodemographic and clinical correlates of suicidal ideation in individuals with ARMS from Pakistan. Method: Participants between the age of 16 and 35 years who met the criteria for ARMS based on the Comprehensive Assessment of At‐Risk Mental State (CAARMS), were recruited from the community, general practitioner clinics and psychiatric units across Pakistan (n = 326). Montgomery and Asberg Depression Rating Scale (MADRS) and Social‐Occupational‐Functional‐Assessment‐Scale (SOFAS) were administered to participants. Results: The prevalence of depressive symptoms and suicidal thoughts in the sample at baseline were 91.1% (n = 297) and 61.0% (n = 199), respectively. There were significant mean differences between groups (mean difference [95% CI]; p‐value) without suicidal ideation and with suicidal ideation on measures of MADRS (−5.47 [−7.14, −3.81]; p <.001), CAARMS non‐bizarre ideas (−0.29 [−0.47, −0.11]; p =.002) and perceptual abnormalities (−0.23 [−0.41, −0.04]; p =.015). Conclusion: These findings indicate that suicidal ideation and depressive symptoms are highly prevalent in individuals with ARMS in Pakistan. Given the pivotal developmental stages that ARMS presents, and the poor outcomes associated with co‐morbid depression, there is an urgent need to prioritize the development of low‐cost and scalable evidence‐based interventions to address psychiatric comorbidity and suicidality in the ARMS population in Pakistan. [ABSTRACT FROM AUTHOR]