bluuebunny/crossref_metadata_2025 huggingface dataset:
A paranoid migrant family – folie à famille
Authors: Oshodi Abiola , Bangaru Raju , Benbow Jackie
Published: March 2016

This report describes a case of folie à famille in which an African man (Mr X), his wife and three daughters travelled around the world as Mr X transmitted his persecutory delusions to his family members. Mr X who had previously had two brief admissions in the UK and in Ireland, received an adequate trial of antipsychotic treatment in his third admission with us in Dublin. During informal contact with his daughter B, it became apparent that the whole family shared his delusions. On her advice, the other family members voluntarily consented for assessment and psychological interventions, they were interviewed separately. All the family members recovered following separation and psychological interventions without antipsychotic treatment. This case illustrates folie imposée, one of the four subgroups summarised by Gralnick1 from the 20th century literature. This family undertook an extreme measure of travelling around the world because of their induced delusions.
Ten year follow-up of children with school refusal
Authors: McCune Noel , Hynes Joanne
Published: March 2016

Objectives: To assess school refusal (school phobia) outcome in adult life.

Method: A 10 year follow-up used questionnaires completed by the target group of young adults and their parents and telephone interviews with their parents. Comparison groups were used.

Results: Psychiatric disorder was present in 30 % and caseness in a further 20%.

Conclusions: There is a need to identify interventions with long lasting effectiveness in this childhood disorder.
Schizophrenia: update on genetics, cognitive behavioural therapy and early intervention
Authors: Kelly Brendan D
Published: March 2016

There have been considerable advances in the understanding of schizophrenia in recent years. This educational review paper focuses on three areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists (MRCPsych): (a) recent advances in the genetics of schizophrenia; (b) advances in cognitive behavioural therapy in schizophrenia; and (c) advances in early intervention strategies for schizophrenia. Relevant papers and systematic reviews are discussed, and recommendations for further reading are provided.
A case of clarithromycin psychosis
Authors: Elahi Fawad , Bhamjee Moosajee
Published: March 2016

A 19 year old girl developed an immediate psychotic reaction following IV clarithromycin (Klacid). She responded to atypical antipsychotics but needed psychiatric hospitalisation. She recovered after a year and is now symptom free without any medication. This is a rare side-effect but needs to be recognised.
A longitudinal study of depression in old age I: outcome and relationship to social networks
Authors: Freyne Aideen , Fahy Sabina , McAleer Angela , Keogh Fiona , Wrigley Margo
Published: March 2016

Objectives:To ascertain the relationship between social network type and depression over time.

Method:A longitudinal outcome study of depressed elderly patients attending an old age psychiatric service was carried out. Subjects were seen at baseline and regular intervals over two years.

Results:Depression severity at baseline and at follow-up times differed according to subjects' social network. Those with more socially integrated networks had the best outcome and those who had more dependent networks had a poorer outcome. There was a lot of movement between networks over time for subjects, with many moving towards more dependent networks.

Conclusions:When treating depression in the elderly it is important to consider the social network and milieu in which the patient resides. Treatments should include strategies encouraging the maintenance and formation of social integration.
A longitudinal study of depression in old age II: depression and physical disability
Authors: Freyne Aideen , Keogh Fiona , Kelly Maria , Wrigley Margo
Published: March 2016

Objectives: As part of an outcome study of depression in older people, the relationship between physical disability and depression was explored at baseline and longitudinally. The aims were to identify whether illness in specific body systems or physical disability was associated with a poorer outcome of depression.

Method: Subjects over 65 with depression referred to an old age psychiatry service were recruited. Depression was diagnosed according to ICD-10 criteria. An in-depth initial assessment obtained data concerning depression severity and illness in specific body systems as well as disability levels. Objective and subjective ratings of health status were also made. Subjects were followed up at three, six, 12, 18, and 24 months. Ongoing assessments were made of depressive symptomatology and of physical status.

Results: Subjects with higher disability levels had more severe depression at baseline. There was no relationship between illness in specific body systems and depression severity. At follow up assessments, those with higher disability scores had poorer outcomes as recorded by depression rating scales and by reviewing the longitudinal course of depression in terms of proportions remaining well, suffering relapses or remaining depressed.

Conclusions: There is an ongoing relationship between depression and disability. Older people with greater physical disability have a poorer outcome of depression. Service providers should be aware of this relationship and respond rapidly and assertively to depression in older people with disability. There should be a lower threshold for initiating treatment in this population.
Body dysmorphic disorder treated with venlafaxine, olanzapine and cognitive behavioural therapy
Authors: McWillliams Stephen , Whitty Marie , Lydon Donal , Clarke Mary
Published: March 2016

Body dysmorphic disorder (BDD, previously called dysmorphophobia) is an excessive preoccupation with trivial or non-existent physical abnormalities, perceived to be deformities. BDD causes significant distress or functional impairment and is both time-consuming and difficult to control. Feelings of low self-esteem, shame, embarrassment and unworthiness are common, as is fear of rejection. This report presents a case of BDD in a young male who sought surgery abroad in an effort to ameliorate his perceived deformity. His suicidal ideation, low mood and anxiety symptoms responded well to venlafaxine, olanzapine and cognitive behavioural therapy; however his overvalued ideas with regard to his physical appearance were slow to improve.
First episode schizophrenia in general practice: a national survey
Authors: Gavin Blanaid , Cullen Walter , O'Donoghue Brian , Ascencio-Lane Juan Carlos , Bury Gerard , O'Callaghan Eadbhard
Published: March 2016

Objective: We sought to establish the views of general practitioners about detecting and managing patients with a first episode of schizophrenia in Ireland.

Method: Twenty per cent of GPs were invited to participate in a cross-sectional postal survey.

Results: Sixty-two per cent (n = 261) participated. Almost all (99.2%) see at least one case of suspected first episode schizophrenia annually. The most commonly (80.7%) encountered symptom is ‘bizarre behaviour’. Many (47.7%) rarely or never prescribe antipsychotics to patients whom they suspect have a first episode of schizophrenia. However, 80.6% of GPs reported that they ‘always’ refer this group of patients to psychiatric services. Over half (57.8%) advised patients with schizophrenia to continue medication for less than a year. A large number of respondents reported that it is difficult to obtain a rapid psychiatric assessment.

Conclusions: GPs want more information about identifying early psychosis, a closer liaison with psychiatric services and a rapid intervention service.
Suicidal behaviour and cognitive problem solving therapy: theory, application and review
Authors: Bannan Noreen
Published: March 2016

Suicidal behaviour is a major public health problem worldwide, both with regard to mortality and treatment of clients who have deliberately harmed themselves. It is a multifaceted problem resulting from complex interactions between social, biological and psychological factors. There is insufficient evidence on which to make firm recommendations about the most effective forms of treatment This is remarkable considering the extent of the problem worldwide, and the importance of dealing with it appropriately in order to prevent further suicides.
Drug treatment programmes in prison: longitudinal outcome evaluation, policy development and planning interventions
Authors: Pugh Julian , Comiskey Catherine M
Published: March 2016

Aims: The aim of this research is to evaluate a seven week abstinence-based drug treatment programme and to use this to assist policy makers in the planning and provision of future programmes.

Methods: Design: Seventy-nine clients were interviewed at two stages. Stage I, prior to the treatment programme, stage II, immediately after the treatment programme. A selected group of 20 clients were followed-up and interviewed at stage III, up to 24 months after the treatment programme.

Setting: All clients were prisoners at Mountjoy Prison, Dublin Ireland.

Participants: Seventy-nine male prisoners were recruited. A sample of 20 of the original cohort of 79 was selected using a snowball sampling method approximately 24 months following treatment. This latter sample of 20 clients consisted of eight prisoners who had re-offended and returned to prison, three prisoners who were still in prison serving their original sentence and nine prisoners who were out of prison. These 20 also participated in a more detailed quantitative and qualitative survey.

Measurements: In order to measure prisoner's criminogenic attitudes and needs the Crime Pics II instrument was used. This is a semantic differential scale which measures attitudes toward offending behaviour. It includes a problem checklist which can be used to measure change over time.

Results: An 82% follow-up rate was achieved on the original group of 79 clients, similarly a follow-up rate of 100% was also achieved for the selected group of 20 clients who were interviewed three times. Regardless of category of client, findings demonstrate an improvement over time for the outcome variables, general attitude to offending, anticipation of re-offending and perception of current life problems. However, the study failed to demonstrate any significant change for the outcome variables victim hurt denial and evaluation of crime as worthwhile.

Conclusions: These results were short lived for many prisoners, who failed to sustain the gains made. Interviews with the cohort of 20 who underwent stage III interviews possibly suggest that those clients who did not receive continuity of treatment post programme, in terms of case management and structured treatment did not fare as well as those who did.
The validity of a latent class typology of adolescent drinking patterns
Authors: Percy Andrew , Iwaniec Dorota
Published: March 2016

Objectives:This study examined the validity of a latent class typology of adolescent drinking based on four alcohol dimensions; frequency of drinking, quantity consumed, frequency of binge drinking and the number of alcohol related problems encountered.

Method:Data used were from the 1970 British Cohort Study 16-year-old follow-up. Partial or complete responses to the selected alcohol measures were provided by 6,516 cohort members. The data were collected via a series of postal questionnaires.

Results:A five class LCA typology was constructed. Around 12% of the sample were classified as ‘hazardous drinkers’ reporting frequent drinking, high levels of alcohol consumed, frequent binge drinking and multiple alcohol related problems. Multinomial logistic regression, with multiple imputation for missing data, was used to assess the covariates of adolescent drinking patterns. Hazardous drinking was associated with being white, being male, having heavy drinking parents (in particular fathers), smoking, illicit drug use, and minor and violent offending behaviour. Non-significant associations were found between drinking patterns and general mental health and attention deficient disorder.

Conclusion:The latent class typology exhibited concurrent validity in terms of its ability to distinguish respondents across a number of alcohol and non-alcohol indicators. Notwithstanding a number of limitations, latent class analysis offers an alternative data reduction method for the construction of drinking typologies that addresses known weaknesses inherent in more tradition classification methods.
Does psychoeducation influence carers' attitudes to treatment of schizophrenia?
Authors: McWilliams Stephen , Hill Shane , Mannion Nora , Kinsella Anthony , O'Callaghan Eadbhard
Published: March 2016

Objective: To measure the impact of a six-week Carer Psychoeducation Program (CPP) on factors that influence attitudes towards treatment among carers and relatives of people suffering from schizophrenia. We also examined which specific attitudes to treatment the CPP had the most effect on.

Method: Between 2002 and 2004, all patients and their relatives continued standard care. During this period, we conducted a historically-controlled open trial, in which 64 relatives completed a 17-item adapted version of the Drug Attitudes Inventory (DAI) before and after the CPP.

Results: Attitudes to treatment improved significantly overall (p < 0.001), an improvement most marked in terms of attitudes to health and illness, attitudes towards the physician and attitudes towards the potentially harmful effects of treatment. No statistically significant improvement was found, however, in attitudes to locus of control or the preventative role of treatment.

Conclusion: A CPP specifically improves family attitudes towards treatment. This finding is clinically important because such attitudes influence adherence which, in turn, influences outcome. The fact that certain attitudes are influenced by the CPP, while others are not, may help to explain the mechanism through which patient outcomes improve.
Determinants of duration of untreated psychosis in an Irish catchment area sample
Authors: Clarke Mary , Browne Stephen , McTigue Orfhlaith , Gervin Maurice , Kinsella Anthony , Waddington John L , Larkin Conall , O'Callaghan Eadbhard
Published: March 2016

Objective: To examine the variables that influence of duration of untreated psychosis (DUP) prior to presentation in persons with a first episode of psychosis.

Method: Prospective examination of consecutive first presentations with DSM-IV psychosis attending a community based psychiatric service.

Results: One hundred and seventy-one patients had an average duration of untreated psychosis of 18 months and a median of five months. The mean duration of untreated mania was 1.5 months, median 0.75 months. DUP was predicted by social withdrawal and diagnosis in the total group and by prodrome in the schizophrenia/schizophreniform group. DUP was not associated with age at onset of psychosis, educational years or living status.

Conclusions: There are significant differences in DUP between diagnostic groups. Increased social withdrawal is associated with a longer DUP.
Characteristics of patients admitted to psychiatric intensive care units
Authors: Kasmi Yasir
Published: March 2016

Objective: A paucity of research exists on the types of patients admitted to psychiatric intensive care units (PICUs), which is important in terms of identifying patient needs, training and service provision. Questions have also been raised as to whether or not ethnic minorities are overrepresented in these units.

Method: A literature review using MeSH headings from a wealth of databases was performed to identify such studies. In addition studies on ethnic minority overrepresentation in psychiatric care were also identified.

Results: Under a dozen studies were identified, mainly from the UK and Australia. Study designs tended to be basic and heterogeneous, but this was reflected in the nature of the study and the data gained. A typical PICU patient emerged, namely a young schizophrenic detained male, belonging to an ethnic minority (if in an inner city), known to mental health services with previous informal, detained and PICU admissions, admitted due to violence and often possessing a forensic history. If a complex need existed, it was usually substance misuse. The inpatient stay tended to be for less than two months and discharge was usually to an acute ward. Ethnic minorities were overrepresented in PICU care.

Conclusions: The literature review highlighted a paucity of good-quality studies in this field. The establishment of a national association of intensive care units as well as national guidelines can only improve services. The reason for ethnic minority over-representation on these units is still far from clear.
Information sharing and risk: a survey of psychiatrists
Authors: Feeney Larkin , Moran Paul
Published: March 2016

Objectives: Historical information is central to decision making in mental health care. Clinical information in the Irish mental health services is currently mostly paper based. Mental health care in Ireland has moved from an institutional medical model towards a community based multidisciplinary model in recent years. This change has resulted in a dispersal of information between multiple sites and professionals, rendering it less accessible, particularly in emergency settings.

This study sought to find out if psychiatrists working in Ireland were experiencing information problems, their ideas about and attitudes towards electronic solutions to these problems, and their views as to what particular pieces of information are indispensable in emergency mental health assessments.

Method: A questionnaire was designed to answer these questions and sent to a representative sample of 150 psychiatrists working in Ireland.

Results: One hundred and nineteen questionnaires (79.3%) were returned complete. Of the 119 respondents 98(82.4%) stated that they had performed emergency mental health assessments within the past year without access to key information and 79(66.4%) said they would have made different decisions in some cases had they had all the available information. Information deficits were particularly apparent in liaison and forensic psychiatry.

Of the respondents 110(92.4%) stated that they would welcome an electronic database designed to support emergency mental health assessments. Misgivings were expressed regarding forms of consent, data quality, breach of confidentiality, resources and much more. Risk factors (ie. self-harm potential), a high alert message and medication details were the data items thought to be most critical.

Conclusions: A shareable set of essential pieces of information (a minimum data set) would offer a balance between patient safety, confidentiality and shareability. A wider debate about solutions to the information deficits in mental health care in Ireland needs to take place among all stakeholders so that this idea can be moved forward.
Psychological assessment of candidates for bariatric surgery
Authors: Davies Mark
Published: March 2016

Objectives: National Institute of Clinical Excellence guidelines indicate that pre-surgical assessment of patients wishing to undergo bariatric surgery should include consideration of psychological factors. This paper describes the psychological characteristics of a cohort of 59 patients.

Method: Patients were interviewed and completed the following psychometric assessments: the Hospital Anxiety and Depression Scale, the Dieting Belief Scale, the Binge Eating Scale, the Emotional Eating Scale, the Generalised Self Efficacy Scale, and the Social Support Questionnaire.

Results: High levels of psychological distress and binge eating were reported. Men more commonly reported a history of alcohol misuse. There was evidence to suggest that psychological distress predated obesity in the majority of cases.

Conclusion: Compulsive eating leading to obesity appears to be both a consequence and a cause of psychological distress. Replacing compulsive eating represents a major post-surgical challenge in the majority of cases. Psychological assessment and follow-up should be offered to each patient.
Electroconvulsive therapy: International guidelines, clinical governance and patient selection
Authors: Rush Gavin , Kimmich Okka , Lucey James V
Published: March 2016

Recent reports from the Inspector of Mental Health Services have highlighted marked variations in electroconvulsive therapy (ECT) prescriptions nationally. This article reviews six international guidelines in order to assess the question of which patients should be referred for ECT treatment and at what stage in their illness. The guidelines display a general consensus in terms of the acutely and severely ill, but differ dramatically in terms of access to ECT outside this category, such as the moderately depressed patient who is treatment resistant but non-psychotic and non-suicidal and who requests ECT due to a previous good response.

The American Psychiatric Association guidelines strongly support the early consideration and use of ECT, highlighting the dangers associated with increased length of illness for individual prognosis. The National Institute of Clinical Excellence (UK) guidelines are the strictest, reserving ECT for the severely ill exclusively and only in cases with a demonstrable failure of alternative treatments. This confusion may ultimately need to be addressed by the Mental Health Commission as data relating to variations in practice may result in inappropriate reductions in access to an established treatment.
One hundred years ago: The Richmond Asylum, Dublin in 1907
Authors: Kelly Brendan D
Published: March 2016

The Richmond Asylum (St Brendan's Hospital) in Grangegorman, Dublin was established in 1815 to help address the unmet needs of the mentally ill in 19th century Ireland. This paper examines the Richmond Asylum Joint Committee Minutes from 1907 in order to explore specific aspects of management and clinical activity at the Richmond Asylum, including: (a) patient populations in the asylums; (b) staffing and management issues; (c) challenges presented by workhouse populations in the early 20th century; and (d) the clinical ‘segregation’ of patients performed by the Medical Superintendent, Dr Conolly Norman, in 1907.
The impact of a rehabilitation and recovery service on patient groups residing in high support community residences
Authors: Kavanagh Annette , Lavelle Ena
Published: March 2016

Objectives: To describe the characteristics of the patient groups with severe and enduring mental illness residing in high support community residences in Dublin North East Mental Health Service and the impact of a rehabilitation and recovery service on their outcomes since the instigation of that service.

Method: Data was collected retrospectively on current and past residents from case notes and staff interviews. Data included demographics, psychiatric history and results of rehabilitation interventions. The results were compiled and analysed using descriptive statistics.

Results: Fifty patients were identified. The majority were male (62%) with a diagnosis of paranoid schizophrenia (66%).The levels of co-morbid alcohol and drug misuse were 48% and 36% respectively. Histories of verbal/physical aggression were found in 70% and noncompliance in 60%. Two thirds of patients had a past history of being detained under the Mental Treatment Act (1945). Ninety-four per cent were unemployed at admission to the residence and following rehabilitation intervention 60% were linked with vocational training programmes and 10% with community employment schemes. ‘New long-stay’ and ‘old long-stay’ patients showed a trend towards poorer outcomes, whereas patients who had previously lived in the community showed a trend towards progressing to lower levels of support.

Conclusions: Positive outcomes were achieved following active rehabilitation interventions, but there remained a cohort of patients whose needs could not be met in a supported community rehabilitation residential programme. This highlights the need to ensure that a range of rehabilitation services from inpatient to supported community placement are provided to meet the needs of patients with severe and enduring mental illness with complex needs.
Opiate-dependent adolescents in Ireland: a descriptive study at treatment entry
Authors: Fagan John , Naughton Leena , Smyth Bobby
Published: March 2016

Objectives:To describe the drug history and co-existing psycho-social problems among under-19 year olds accessing treatment for opiate dependency, including methadone maintenance, and examine for any gender differences.

Method:A descriptive study of under-19 years assessed at the largest drug treatment clinic in Dublin, Ireland, between October 2000 and September 2006. Data was obtained through review of case notes, assessment questionnaires and urine drug screens.

Results:Eighty-six young people were included. Their mean age was 16.8 years. Forty-six (54%) were female. Only 26 (30%) reported an intact family of origin. Twenty-three (27%) had been in care. Mean age for first use of any illicit drug was 12.4 years, and for heroin was 14.8 years. The mean age of leaving school was 14.4 years; 42 (49%) first tried heroin after leaving school. Forty-one (48%) had a history of homelessness. Forty-four (51%) had previously injected; 26 (30%) were currently injecting. Fifty-six (65%) had not been screened for blood-borne diseases; twenty-one (24%) subsequently tested positive for hepatitis C. Thirty-eight (48%) had previous convictions; 33 (38%) were facing charges. Forty-five (52%) had previously seen a psychiatrist; nine (11%) had received inpatient psychiatric treatment. Boys were more likely to leave school early, have a substance-abusing sibling, and to have a past conviction. Girls were more likely to have a partner, and have taken a deliberate overdose.

Conclusions:This study highlights the multiple and complex needs of teenagers abusing opiates. Services seeking to meet their needs will require a broad range of interventions and excellent interagency co-operation.
Recurrent transient parotid gland swelling with clozapine therapy
Authors: Kathirvel Natarajan , Ismail Shajahan , Spence Sean A
Published: March 2016

We report a case of recurrent parotid gland swelling in a man receiving clozapine. Our aim is to raise awareness of this iatrogenic condition and to review what is known of its pathogenesis and management.
The economic cost of schizophrenia in Ireland: a cost of illness study
Authors: Behan Caragh , Kennelly Brendan , O'Callaghan Eadbhard
Published: March 2016

Objectives: Although there are many published reports about the human cost of schizophrenia, there are far fewer estimates of its economic cost, particularly in Ireland. The aim of this study was to provide a prevalence-based estimate of the costs associated with schizophrenia in Ireland during 2006.

Method: Using standard Cost of Illness (COI) procedures we compiled data from many sources including the Health Research Board, the Department of Health and Children and other government publications. Costs relating to health and social care, informal care, lost productivity, premature mortality and other public expenditures were included. Where national data were unavailable, we used bottom-up data from a geographically defined catchment area study and, in some instances, costs from two catchment areas were averaged. We did not measure human or intangible costs.

Results: The estimated total cost of schizophrenia was €460.6 million in 2006. The direct cost of care was €117.5 million and the burden of indirect costs was €343 million. The cost of lost productivity due to unemployment, absence from work and premature mortality was €277 million. Within indirect costs, the expenditure on informal care borne by families was €43.8 million.

Conclusions: Schizophrenia is not a very common condition but is an expensive one. This is attributable to its young age at onset, relatively low mortality rate and high severity particularly in terms of its impact on future employment. Measures to improve outcomes coupled with measures to improve employment such as supported employment strategies may impact significantly on the cost of schizophrenia. The study is limited because the national unit costs of many variables are not directly available and these Irish data are likely to be an underestimate. However, the results are comparable with a 2005 cost of illness study UK study.
Learning disability and forensic mental healthcare in 19th century Ireland
Authors: Kelly Brendan D
Published: March 2016

The Irish College of Psychiatrists recently reported that “the needs of people with learning disability and offending behaviour pose a huge challenge to service providers. The vulnerability of people with a learning disability who come into contact with the criminal justice system is well described and noted.” The College noted that “the population with learning disability who offend does not easily fit into existing services” and reported that “the majority of service providers strongly supported the urgent development of a forensic learning disability service.”

The challenges presented by individuals with learning disability and offending behaviour are not specific to Ireland or to this period in history. The purpose of the present paper is to explore issues related to learning disability and offending behaviour in 19th- and early 20th-century Ireland.

More specifically, this paper presents original, previously unpublished case material from the archival medical records of the Central Mental Hospital, Dublin in order to illustrate specific aspects of the institutional experience of individuals with learning disability who were charged with offending behaviour in nineteenth-century Ireland.

The Central Mental Hospital, Dublin was established as the Central Criminal Lunatic Asylum in 1845 under the provisions of the Lunatics Asylums (Ireland) Act (1845). Individuals were to be committed to the Central Criminal Lunatic Asylum if they were declared ‘guilty but insane’ at time of trial or offence, or if they developed mental illness and became difficult to manage while in detention elsewhere. The Central Criminal Lunatic Asylum opened its doors to admissions in 1850 and by 1853 there were 69 male and 40 female inpatients.
Neonatal outcome following buprenorphine maintenance for opiate dependency
Authors: Fagan John , Keenan Eamon
Published: March 2016

Methadone substitution improves maternal and neonatal outcomes. However methadone induced neonatal abstinence syndrome (NAS) is common. Buprenorphine-exposed neonates may be at a lower risk of NAS. Currently in the Republic of Ireland, buprenorphine does not have a special licence for use in pregnancy. We describe here the history and neonatal outcomes of the first Irish woman maintained on buprenorphine during two pregnancies.

Supervised urinanalysis on this mother between and throughout both pregnancies did not reveal any illicit drug use. She delivered two post-term babies of normal birth weight and length. The second infant required treatment for NAS for 21 days with morphine sulphate. Although the use of buprenorphine in pregnancy does not remove the possibility of NAS, neonatal outcomes of buprenorphine-maintained women compares favourably to methadone. As the use of buprenorphine becomes more established in Ireland, the management of buprenorphine-exposed neonates will become more common.
Investigation of schema modes currently activated in patients with psychiatric disorders
Authors: Khalily Muhammad Tahir , Wota Anna Paulina , Hallahan Brian
Published: March 2016

Objectives: To investigate schema modes currently activated in individuals with psychiatric disorders and to attain a greater understanding of healthy and dysfunctional schema modes in this population. Furthermore, we wish to ascertain if individuals who fulfil criteria for clinical (psychiatric) disorders with the Minnesota Multiphasic Personality Inventory (MMPI), also manifest dysfunctional modes and weaker healthy modes on the Schema Mode Inventory (SMI).

Method: Fifty individuals were administered the MMPI and SMI during routine psychological assessments between September 2008 and June 2010.

Results: Both healthy schema modes (Happy Child (HC) and dysfunctional schema modes (Compliant Surrender (CS), Detached Self-soother (DSS) and Demanding Parent (DP)) were evident in this population. Positive correlations were noted between several dysfunctional schema modes from the Child, Maladaptive Coping and Maladaptive Parent domains of the SMI and several scales of the MMPI including: Depression (D), Psychopathic deviate (Pd), Masculine feminine (Mf), Paranoia (Pa), Psychasthenia (Ps), Mania (Ma), Schizophrenia (Sc), and Social introversion (Si) (p < 0.001). A negative correlation (p < 0.001) was found between the Healthy Adult (HA) and Happy Child (HC) schema modes of the SMI and the Hypochondriasis (Hs), Depression (D), Psychopathic deviate (Pd), Psychasthenia (Pt), and Social introversion (Si) scales of MMPI.

Conclusion: This study demonstrates the presence of several dysfunctional schema modes in individuals with a wide range of clinical (psychiatric) disorders and a strong correlation between dysfunctional schema modes and clinical disorders of the MMPI. The SMI can aid in the assessment and understanding of individuals with a wide range of psychiatric disorders and can also form the basis for Schema Focused Therapy (SFT), a therapy showing promise for a number of clinical conditions, particularly borderline personality disorder.
Psychoeducation: priorities of service users and service providers
Authors: Ahmed Mohamed , Reilly Michael , Cassidy Carol , Mannion Laura
Published: March 2016

Objectives: The objective of this study was to ascertain the topics patients and mental health professionals thought should be covered in a psychoeducation programme at a day hospital.

Methods: Patients at the psychiatric day hospital and mental health professionals were invited to complete the study questionnaire. Replies from 101 participants were analysed.

Results: The patients and mental health professionals generally agreed regarding the topics to be covered in the eight-week psychoeducation programme. Patients tended to score ‘suicide’ as more important than did the mental health professionals.

Conclusions: Patients in a day hospital setting and mental health professionals share similar concerns about what information needs to be imparted about the patients' illnesses. However, suicide is seen by patients as a more important topic in such a setting.
An unusual cause of autobiographical memory loss
Authors: Naughton Marie , Coen Robert , Doherty Colin , Lawlor Brian
Published: March 2016

We describe an unusual cause of autobiographical memory loss in a 55 year old man who presented with prominent memory loss for significant events in his life over a period of five years with evidence of patchy memory loss for events prior to this. It was associated with emotional lability and was complicated by a number of tragic events in his life in the previous four years. In addition there were a number of brief episodes (< 30 mins) where he would transiently lose his memory for events including for hours, days or months prior to the event. Neuropsychological assessment confirmed prominent autobiographical memory loss with minimal deficits in other domains. An electroencephalogram (EEG) revealed a simple partial seizure arising from the right temporal lobe, pointing to a diagnosis of Transient Epileptic Amnesia. He was commenced on anti-epileptic medication and responded both subjectively and objectively. There are approximately 94 cases of TEA described in the literature and the diagnostic criteria and postulated aetiology of this illness is discussed here. Clinicians need to have high index of suspicion of epilepsy when assessing a patient with prominent autobiographical memory impairments.
The physical health of residents of long-stay wards in Carlow/Kilkenny
Authors: Udo Itoro , Mooney Mary
Published: March 2016

Objectives:This audit is supported by regulations within the Mental Health Act 2001. It is in response to the Mental Health Commission Strategic Priority Number One, Quality Framework, 2002-2008 which aims to promote high standards of physical examination in the care of long-stay residents of psychiatric facilities. It is based on improved awareness of adverse effects of mental illness or its treatment on physical health. This awareness informs better practice.

Method:Physical examination proforma and case notes of all long-stay residents in wards in Carlow and Kilkenny were assessed over a six month period to examine the quality of physical examination. Following departmental meetings and literature review, standards of care as recommended by the Royal College of Psychiatrists in Occasional Paper 67 and Irish statutory documents were agreed to be the appropriate benchmark.

Results:Areas of strength were the examination of ‘routine’ systems (> 92%), ie. cardiovascular, respiratory, alimentary, central nervous, genitourinary and the frequency of clinical review by treating psychiatric team. Areas needing improvement were eye (8%) and ear (3%) examinations, measurements of weight (58%), height (1.6%), body mass index (1.6%), waist circumference (0%), investigating for prostatic specific antigen (50%), discussion of results of physical examination and investigations with the residents (both 0%) and referral to BreastCheck (36%).

Conclusion:A new physical examination form has been created for long-stay residents to correct these deficiencies and a new departmental policy document setting out a standard of practice consistent with recommended practice and general statutory requirements has been put into place.
Therapeutic alliance in forensic mental health: coercion, consent and recovery
Authors: Donnelly Vidis , Lynch Aideen , Devlin Conal , Naughten Leena , Gibbons Olivia , Mohan Damian , Kennedy Harry G
Published: March 2016

Objective: We examined the Working Alliance Inventory (WAI) and Interpersonal Trust in Physician (ITP) in a forensic psychiatry hospital, where all patients were detained under mental health legislation for psychosis. We hypothesised that working alliance and trust are bilateral and can be measured.

Method: We adapted the WAI and ITP minimally so that patients rated both their treating psychiatrist and primary nurse. We also adapted them minimally so that clinicians could rate WAI and ITP with the patient. A total of 81 of 83 patients completed the assessments. The clinicians (seven consultant psychiatrists and 43 nurses) also completed a minimally altered version of the same questionnaires. All three (patient, nurse and psychiatrist) were blind to the ratings of the others.

Results: Cronbach's alpha was greater than 0.9 for both patient and clinician versions of the WAI and greater than 0.8 for the ITP. The WAI and ITP correlated with each other (Spearman r > 0.67 for patients, for psychiatrists and for nurses). Patients rated clinicians higher than clinicians rated patients. Ratings were higher in pre-discharge wards than in acute wards. Patients' ratings of WAI for their psychiatrist and nurse correlated r = 0.75, and patients rating of IPT for psychiatrist and nurse correlated 0.67. Psychiatrists correlated with nurses 0.38 for WAI, 0.53 for IPT. Psychiatrists and patients mutual ratings correlated r = 0.35 for WAI, 0.24 for IPT. Nurses and patients correlated r = 0.34 for WAI, 0.25 for IPT. All correlations were statistically significant. Mental state (PANSS) and global function (GAF) correlated with all ratings and confounded most patient-clinician correlations.

Conclusion: Working alliance and interpersonal trust can be measured reliably even in forensic settings. The extent to which they measure a mutual quality is unclear.
A study of consultant psychiatrists' response to patients' suicide
Authors: Kelleher Eric , Campbell Aisling
Published: March 2016

Objectives: A patient's suicide is arguably the event of most concern to consultant psychiatrists. Given the rise in the rate of suicide in the Republic of Ireland, the impact it has should not be underestimated. The aims of the study were: to assess the effect a patient's suicide has on a consultant's personal and professional life; to identify what factors modulated or exacerbated their response to the suicide; and to highlight what was shown to be beneficial in coping with the aftermath.

Methods: Following a literature review, a questionnaire from a previous study was chosen. This was sent to 74 consultants working in the Munster province. It asked consultants to recall their ‘most distressing’ suicide and their response to it. The results were analysed using quantitative methodology. A further literature review was conducted on the issues raised.

Results: The questionnaire response rate was 67.5%. A total of 80% of consultants had a patient commit suicide under their care. In the case of 27.5%, consultants said that their personal lives had been affected by the suicide and 32.5% said that their professional lives had been affected. The majority of those affected were recently appointed consultants. Consultants' peers and team were significant sources of support, as were team meetings. A total of 57.5% of consultants said that their management of future suicidal patients had changed following the suicide.

Conclusions: A proportion of consultants experience negative effects in their lives as a consequence of patient suicide. However the support of consultant peers, the team and team meetings may help in the aftermath.
Tardive dysphoria: antidepressant-induced chronic depression
Authors: El-Mallakh Rif S , Roberts R Jeannie , Swann Alan , Rutherford Pat R. , Surja Anton
Published: March 2016

Objectives: A significant number of depressed individuals experience inadequate benefit from long-term antidepressant use. This paper investigates the hypothesis that in some individuals persistent use of antidepressants may be prodepressant.

Methods: Literature regarding the effect of long-term use of antidepressants was reviewed by searching PubMed and Ovid data bases with terms: antidepressant tachyphylaxis, treatment-resistant depression, chronic depression and antidepressant tolerance.

Results: Antidepressant treatment-resistant patients frequently had a positive initial response to antidepressants. When resistance appeared, initial increases in dose or medication changes usually resulted in transient improvement. Eventually, the episodic course of the original depressive illness was replaced with a continuous, unresponsive depressive syndrome. We propose the term tardive dysphoria to describe this phenomenon.

Conclusions: The phenomenon of antidepressantinduced depression, or tardive dysphoria, needs to be experimentally examined in blinded, randomised antidepressant discontinuation studies.
Caffeine and clinical change in a patient with schizophrenia on a long-stay ward
Authors: Kim Aram , O'Hanlon Mary
Published: March 2016

We report a case of a 33-year-old male patient with schizophrenia, who showed significant and persistent changes in psychotic and mood symptoms relating to his caffeine intake.
Tobacco smoking and mental illness: important considerations
Authors: Feeney Sabina , Hallahan Brian
Published: March 2016

Tobacco smoking is a contributory factor in the death of 50% of individuals who are regular or heavy smokers (The Office of Tobacco Control Ireland defines a regular smoker as someone who smokes 11-20 per day and a heavy smoker as someone who smokes 21 or more cigarettes per day). The World Health Organisation (WHO) regards tobacco smoking as the leading preventable cause of death worldwide. In Ireland, approximately 750,000 people smoke tobacco regularly (23.5% of the population) with 7,000 Irish people dying annually from smoking-related causes. Although there are no exact figures for prevalence rates of smoking in individuals with mental illness in Ireland, international studies unequivocally state that the prevalence of smoking is significantly higher in those with mental illness, with greater nicotine intake and increased prevalence of nicotine dependence also reported. Furthermore people with mental illness experience greater withdrawal symptoms and have lower cessation rates when attempting to stop smoking compared to the general population.
Changes in perceptions and emotions before and after refeeding in anorexia nervosa: a pilot study
Authors: Kennedy Sidney H , Katz Randy , Ford Christine G , Ralevski Elizabeth
Published: March 2016

Objective: Physiological and psychological distortions associated with eating are recognised within the syndrome of anorexia nervosa. The purpose of this study was to compare subgroups of restricting and bulimic anorexic patients (AN-R and AN-B) with control subjects, and with themselves after six weeks of refeeding and weight gain, on a series of indices before and after a standard meal. Method: Nineteen consecutively admitted female AN patients completed visual analogue ratings of hunger, satiety, depression, urge to binge, urge to vomit and food craving during the first week and sixth week of hospitalisation. A female control group of seven subjects completed similar ratings for one week. The patient ratings were compared to those of the control subjects at baseline before and after a meal. Further comparisons between the two patient groups were also carried out six weeks after treatment. Results: As expected, AN patients reported significantly higher ratings of depression, urges to vomit, urges to binge and higher satiety levels when compared to controls. Comparisons between the patient subgroups revealed that at baseline AN-B patients had significantly higher urges to vomit that AN-R patients after meals, and reported significantly less satiety both before and after eating. Also, an increase in depression after the meal, at baseline, was reported by both groups although after six weeks higher levels of depression were recorded before rather than after the meal. There was also a significant decrease in food cravings after six weeks compared to baseline for both patient groups.

Conclusions: The findings in this study provide further evidence that clinically significant differences exist between subtypes of patients suffering from anorexia nervosa, and highlight the differential, change in various symptoms during intense hospital treatment.
A study of deliberate self-poisoning in a Dublin hospital 1986 – 1990
Authors: Coakley Fergus , Hayes Catherine , Fennell John , Johnson Zachary
Published: March 2016

Objective: The study was undertaken to determine the current demographic and clinical features of cases of deliberate self-poisoning (DSP) presenting to an acute general hospital and to compare the findings with previous work in Ireland and elsewhere. Method: Four hundred and sixty seven consecutive admissions for DSP presenting to a Dublin hospital between 1986 and 1990 inclusive were identified retrospectively and the case notes reviewed. Data was collected on age, sex, marital status, past history, date of DSP, drugs used, motivating factors and outcome. Results: The peak age of DSP was 15-24 years. The female:male ratio was 1.5:1. There was an increased incidence of DSP in women in July and August. In 32% there was a previous history of DSP. Benzodiazepines, antidepressants and analgesics/anti-inflammatories were the commonest drugs taken. There was a significant medical complication in 10.5% of cases, but no fatalities. Twenty-five percent of patients were subsequently admitted to psychiatric inpatient care. Conclusions: DSP is an ongoing problem. The summer peak in females may be related to the parenting burden during the summer recess. The high rate of repetition suggests a significant reduction could be achieved with successful strategies for secondary prevention. The high rate of psychiatric in-patient referral may be related to a low threshold for admissions to Irish psychiatric hospitals.