SummaryCognitive dysfunction is one of the major contributors to the burden of epilepsy. It can significantly disrupt intellectual development in children and functional status and quality of life in adults. Epilepsy affects cognition through a number of mechanisms in complex interrelationship. Cognitive deficits in epilepsy may be treated indirectly through aggressive seizure control using anti-epileptic drugs or surgery, and by treating comorbid conditions such as depression. The beneficial effects of reducing seizures may offset the adverse cognitive side-effects of these therapies. Direct treatment of cognitive impairment in epilepsy mainly involves memory rehabilitation. Other direct treatments are mostly experimental and their evidence base is currently poor.

AimsIn 2019 members of the Liaison Psychiatry Department at Frimley Park Hospital completed an audit of the referrals to the service1. The quality of referrals was found to be highly variable, for example only 28% included a risk assessment and frequently omitted both past psychiatric and past medical histories. As such an intervention was designed involving three parts;Multidisciplinary education of staffNew and more readily available referral guidelinesNew referral formThis re-audit seeks to complete the audit cycle and assess the impact of the intervention.MethodThe first 50 referrals to the Liaison Psychiatry Department of Frimley Park Hospital during February 2021 were assessed using the following criteria:Staff type, referral source, physically fit for assessment, physical cause ruled out, drugs / alcohol involved, appropriate reason for referral, clinical question asked, did final diagnosis match referral diagnosis, risk assessment included, information about admission included, past psychiatric history included and past medical history included.The percentage of referrals received for each criterion (e.g. the percentage with a risk assessment completed) was then derived from the data.ResultThere has been a marked improvement in a variety of areas. The percentage of referrals containing a risk assessment increased from 28% to 96%. This is likely due to the risk box now requiring an entry prior to being able to submit the referral form. Similarly the percentage containing past psychiatric history has risen from 38.8% to 90%. Previously 46.2% of referrals contained a working diagnosis which was not consistent with the clinical picture, but again this has improved, with 60% of initial diagnoses now matching the final outcome. There are however areas for improvement. Only 14% of referrals contained a specific clinical question, which is lower than the 20% achieved previously. This may be because the new referral form does not provide a specific free text box for this.ConclusionThe intervention yielded a marked improvement in the quality of referrals received by the Liaison Psychiatry Department at Frimley Park Hospital, and it is the intention to continue to use the current process. Based on the new results we will look to make small adjustments, for example adding a free text box for a specific clinical question and emphasising the importance of this information.

emotional vocalisations? A previous study on non-verbal emotional vocalisations has shown a cross-cultural effect in Western and African participants. However, nobody has ever investigated the cross-cultural differences between Japanese and Caucasian participants in their emotional response to non-verbal vocal sounds. In the present study, we aimed to investigate cross-cultural effect between Caucasian subjects and Japanese subjects when the subjects listen to nonverbal affect bursts. Method 30 Japanese subjects (15 males) participated in this study. The data of Japanese subjects were compared with data from 30 Canadian subjects (15 males). Subjects listened to the Montreal Affective Voices (MAVs), which consist of a database of nonverbal affect bursts portrayed by Canadian actors. Each voice was evaluated using three criteria: perceived emotional intensity in each of the eight emotions (Anger, Disgust, Fear, Pain, Sadness, Surprise, Happiness, and Pleasure), perceived valence, and perceived arousal. To investigate cross-cultural differences between Japanese and Canadian participants, mixed 238 ANOVAs with Group (Japanese, Canadian) and Emotion (eight emotions) as factors were calculated on ratings of Intensity, Valence, and Arousal. Results Significant Group 3 Emotion interactions were observed for ratings of intensity, valence and arousal (intensity: F(5.5, 313.5) ¼ 9.137, p<0.001, valence: F(4.3, 244.3) ¼ 25.101, p<0.001, arousal: F(4.4, 250.5) ¼ 8.955, p<0.001). Post-hoc tests showed that intensity ratings from Japanese listeners were significantly higher than ratings from Caucasian listeners for angry, disgusted, fearful, surprise, and pleased (p<0.05/8). Further, valence ratings from Japanese listeners were significantly higher than ratings from Caucasian listeners for angry, disgusted, fearful, painful, surprised (p<0.05/9), whereas valence rating of pleased in Japanese listener was significantly lower than in Caucasian listener (p<0.05/9). Arousal ratings of sad vocalisations by Japanese listeners were significantly higher than by Caucasian listeners (p<0.05/9). Conclusion This study demonstrates important cross-cultural differences in the perception of non-verbal affect bursts and extends recent observations by showing that these cross-cultural differences are also found for negative emotions.