bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological factors associated with coronary heart disease
Authors: Marusic Andrej
Published: March 2016

Objectives: Psychological coronary-proncncss is most probably one of the first recognised risk factors for coronary heart disease (CHD). The mechanisms by which psychological risk factors might exert their influence on the cardiovascular system arc less clear than those for the more standard biological risk factors. The aim of this review was to classify all possible mechanisms of potentiation of CHD by psychological factors.

Method: A MEDLINE search was conducted by selecting literature on both standard biological risk factors (eg. dyslipidaemia, hypertension, smoking) and psychological risk factors (eg. personality traits, behavioural characteristics, coping with stress) for CHD.

Results: It was suggested that six biological mechanisms could mediate psychological influences specifically for CHD, of course, together with the seventh mechanism of general alterations in health-related behaviours. These are: increased oxygen demand of the heart muscle, decreased blood supply to the heart muscle, increased concentration of blood, enhanced blood clotting, increase in cholesterol and other plasma lipids, disturbances of blood sugar level, and alterations in health-related behaviours.

Conclusions: If more studies of CHD were conducted with both physical and psychological risk factors simultaneously, it would be possible to investigate which of the above suggested mechanisms are important, which could in turn substantially improve both primary and secondary preventive measures.
Mental health status of homeless children and their families
Authors: Waldron AnneMarie , Tobin Genevieve , McQuaid Paul
Published: March 2016

Objectives: To examine the mental health status of homeless children and their families living in a supported temporary housing project.

Method: The assessment measures used: (i) the 28-item General Health Questionnaire (GHQ); (ii) the Child Behaviour Checklist (CBCL); and (iii) the Parenting Stress Index (PSI). The population studied consisted of 14 families and 31 children. Children aged two to 16 years were eligible for the study. Most of the families (12/14) assessed were single parent (mother only) family units.

Results: The General Health Questionnaire was completed by the 14 mothers and two fathers. Of the mothers 28% (4/14) indicated the presence of psychiatric ‘caseness’. The Child Behaviour Checklist (CBCL) was completed on 31 children by the mothers. More than a third of the children (12/31) had a Total Problem Score above the ‘clinical’ threshold, indicating the presence of mental health problems of sufficient severity to merit referral for treatment. Of the children 45% (14/31) manifested externalising problems in the ‘deviant’ range, while 29% of the children (9/31) manifested internalising problems in the ‘clinical’ range. In all, when the CBCL scores were examined within each family, 78% (11/14) had at least one child with a CBCL dimension of clinical significance. The Parenting Stress Index was completed by each mother. Of the mothers 70% (10/14) obtained scores in the critical range. They reported feeling incompetent in their parenting role, being dominated by their children's needs and feeling social isolated from their relatives and peers. Their scores also indicated poor self-esteem and significant depressive symptoms. Of note the peak score was the lack of emotional and active support from the other parent.

Conclusion: This study revealed a high level of stress and clinical morbidity in this group of homeless mothers and their children and the need to provide appropriate mental health supports and services for them.
Responses of football fans to relegation of their team from the English Premier League: PTS?
Authors: Banyard Philip , Shevlin Mark
Published: March 2016

Objectives: To measure the level of psychological distress caused to supporters of a football team by relegation from the English Premier League. The relationship between age, sex and psychological distress are examined.

Method: Opportunity sample cross-sectional survey. Participants were approached through networks of fans and through e-mail networks. Participants were supporters (n = 65) of two relegated premiership football teams. Participants completed the Impact of Event Scale.

Results: Mean total Impact of Event Scale scores indicated a clinically significant degree of psychological distress for the majority of respondents. Age or sex of the participants did not predict Impact of Event Scale scores.

Conclusions: The results are discussed in terms of the magnitude of Impact of Event Scale scores in relation to other stressors. It is concluded that the impact of such sporting events is psychologically significant. The psychological literature has considered traumatic stress responses to a number of stressors such as threats to life, threats to psychological well-being, threats to physical/ psychological well-being of others, witnessing traumatic events and involvement in a human or natural disaster.
Fact or fantasy? A review of recovered memories of childhood sexual abuse
Authors: DelMonte Michael M
Published: March 2016

More than a century ago Freud provoked a bitter controversy concerning alleged recollections of childhood sexual abuse: Were they fact or fiction? This debate is still ongoing, with some professionals stubbornly holding on to deeply entrenched and polarised positions. On the one side there are those who continue to deny the veracity of all ‘recovered memories’, and thus also of the implicated psychological defenses of repression and dissociation. At the other extreme are those therapists who simplistically assume that particular symptoms invariably imply sexual abuse. Over the decades there is a growing corpus of anecdotal, clinical and, more recently, research evidence supporting the contention that childhood sexual abuse, like all other trauma, can be forgotten for days, and even for many years, before being recalled. However, the reconstruction of these memories is a complex and, at times, a rather fallible process.
Assessment following deliberate self-harm: who are we seeing and are we following the guidelines?
Authors: McCauley MacDara , Russell Vincent , Bedford Declan , Khan Ashar , Kelly Roisin
Published: March 2016

Objectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.

Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.

Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.

Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.
Trichotillomania
Authors: O'Sullivan Martin J , Redmond H Paul
Published: March 2016

Trichotillomania is a relatively uncommon condition that classically occurs in young females. It can result in trichobezoar formation, which is usually managed successfully by surgical intervention, although rarely it can be fatal. This article presents a brief review of trichotillomania. A literature search was performed for ‘trichotillomania’ using the PubMed database, and relevant papers and their references were researched. This review commences by defining the condition and considering its presentation and its prevalence. Diagnostic dilemmas including differential diagnosis and the uncertainty about structural abnormalities in the brain as indicated by magnetic resonance imaging findings are then reviewed. Finally we examine the current treatment options of this interesting condition.
Infanticide and child murder — admissions to the Central Mental Hospital 1850-2000
Authors: Mulryan Niamh , Gibbons Pat , O'Connor Art
Published: March 2016

Infanticide and child murders have been known to all civilisations throughout time. This study looks at the problem from an Irish perspective, particularly with regard to the forensic psychiatry service. The case notes and legal files of 64 women admitted to the Central Mental Hospital (CMH), Dublin, between May 1850 and 2000 were examined. This group represents a complete sample of female inpatients charged with these offenses over the 150 year history of the institution. Sociodemographic and clinical data were analysed to provide psychiatric and social backgrounds to the cases. There has been a considerable decrease in the number of women admitted to the CMH on charges or conviction for infanticide and child murder in recent years. It appears that the attitude of the judiciary to these women has altered. The cases are discussed in the context of the prevailing attitudes of the era.
A delusion of immortality – the dilemma of the Struldbruggs
Authors: Cullivan Rachael , Lawlor Brian A
Published: March 2016

We describe a lady with a history of recurrent psychotic depression, together with a persistent delusion of immortality, which appears to be independent of the depressive illness. It is of interest that this woman is a patient of the hospital founded by Dean Jonathan Swift, who described a people stricken with a similar dilemma of unhappy immortality over 200 years ago.
The prevalence of neuroleptic malignant syndrome in learning disability
Authors: Morgan Caryl N , Rowe Renarta
Published: March 2016

Objectives: No information has been published on the incidence of neuroleptic malignant syndrome in learning disability. However, some studies of individuals who have developed neuroleptic malignant syndrome have suggested that individuals with learning disabilities may be over represented. This study aims to identify the association between learning disability and neuroleptic malignant syndrome.

Method: A retrospective case-note analysis was performed with psychiatric case notes for clients with learning disability, in two geographical catchment areas. It was recorded whether clients had been exposed to neuroleptics, and whether any neurological symptoms had subsequently developed which could have been suggestive of neuroleptic malignant syndrome.

Results: It was found that 301 individuals had been exposed to neuroleptics, out of 570 case notes examined. Only one case of neuroleptic malignant syndrome was identified, giving a lifetime prevalence rate of 0.3%.

Conclusion: This study failed to demonstrate a higher than expected prevalence of neuroleptic malignant syndrome in clients with learning disability exposed to neuroleptics.
Predictors of discontinuation on clozapine: a population study
Authors: MacGillivray Steve , Cooper Steve J , English Barbara , Millar Helen , Williams Brian
Published: March 2016

Objectives: A quarter of people with schizophrenia may be classed as ‘treatment-resistant’. Clozapine is an antipsychotic that holds significant potential benefit for this patient group and has recently been recommended by the National Institute for Clinical Excellence. Early discontinuation is common. This study explores the factors that predict such discontinuation.

Method: This retrospective cohort design was carried out on two hundred and one people with treatment resistant schizophrenia who had commenced clozapine between 1990 and 1997 identified from the Clozaril Patient Monitoring Service (CPMS) in Northern Ireland. Clinical and socio-demographic data was collected for three years before and after commencement on clozapine. Kaplan Meier survival analyses were conducted to identify differences in discontinuation rates according to a range of variables.

Results: Forty-five per cent of patients had discontinued before three years. No difference in rates were found between men and women, nor whether side-effects were reported or not Patients who had commenced clozapine at an older age had significantly higher cessation rates. People who had started clozapine at age 50+ were four times more likely to stop taking clozapine within three years than people aged between 17-29 years.

Conclusions: Differences in continuation rates may be due to a number of factors. Treatment resistance may increase with age, side-effects may worsen or patient willingness to tolerate such effects may reduce. Alternatively, clinicians may be more anxious about prescribing clozapine as levels of co-morbidity increase. Further research is required to identify precise reasons and develop interventions to reduce discontinuation rates among older patients.
Problems experienced by young men and attitudes to help-seeking in a rural Irish community
Authors: Russell Vincent , Gaffney Paul , Collins Katrina , Bergin Aedamar , Bedford Declan
Published: March 2016

Objectives: Suicide is now the commonest cause of death among young Irish males. The literature identifies a wide range of contributory risk factors in suicide. However, a number of realities have frustrated clinicians' efforts in the area, including the reluctance of young males to engage in mental health services. In this study, we sought to explore the problems experienced by young men in a rural setting and their attitudes towards seeking help.

Methods: Focus groups were employed to generate themes for a qualitative and quantitative questionnaire which was administered to a community sample of 71 young men (22.4% of the total number of males aged 16-30 years in the area) and 79 key informants. The questionnaires contained demographic items and examined available social outlets, types and extent of difficulties experienced by young men and perceptions of and access to potential sources of support.

Results: Both young men and key informants reported that peer pressure and alcohol misuse are areas of most difficulty, that friends and family are the preferred sources of support and that young men view much existing professional help as unacceptable.

Conclusions: This study provides a basis for the next stage in the research cycle and also supports the viability of building a partnership between the health services and the local community in developing future suicide prevention strategies for young men.
Withdrawal delirium with dance drug ‘liquid ecstasy’ (GHB)
Authors: Garvey Ruth , Fitzmaurice Brian
Published: March 2016

We wish to describe a case of gamma hydroxyl butyrate (GHB) withdrawal, including seizure activity in a 34 year old male, who had been taking the substance over a two year period. The syndrome has many aspects in common with alcohol withdrawal (delirium tremens) and benzodiazepine withdrawal (long duration of symptoms), however detoxification presents many challenges for clinicians.
A brief adherence therapy: training issues and patients' satisfaction
Authors: Boilson Marie , Murdoch Jane M , Hull Alastair M , Hamilton Ross J , Scott Jan
Published: March 2016

Objectives: Medication non-adherence in affective disorder is an area of concern. Abbreviated cognitive therapy for adherence (ACTA) is an intervention specifically designed to address this. Our objectives were to explore psychiatric trainees' experiences of delivering this therapy, and to examine patient satisfaction using the Client Satisfaction Questionnaire (CSQ).

Method: This preliminary study took place in two centres in Scotland. The experiences of five higher psychiatric trainees who underwent training in this novel approach were gathered at a ‘brain storming’ meeting after completing training, which included clinical application of the intervention. Also included is the preliminary feedback from a small number of participants involved in a randomised controlled pilot study of ACTA provided by these same trainees. In this pilot, 15 participants with bipolar affective disorder were allocated to receive ACTA (n = 7) or treatment as usual (TAU) (n = 8) and both groups completed a CSQ (client satisfaction questionnaire) at the end of the study.

Results: It was possible to learn and use this approach with limited previous experience of cognitive behavioural techniques. Longer structured sessions with the patients fostered the development of a collaborative relationship and facilitated negotiation of a treatment plan. There was 100% attendance rate for those receiving ACTA. Satisfaction scores for both the ACTA group and TAU group were high with median scores greater than 55 from a maximum of 60 in both groups. The ACTA group made additional positive comments.

Conclusions: Training in a brief therapy, such as ACTA, appears possible during psychiatric training and may represent a useful set of cognitive and behavioural techniques for busy clinicians. Preliminary findings suggest that patients like it.
Doctor Foster ‘went’ to Gloucester: the origin and aims of The Royal College of Psychiatrists
Authors: Foster Tom
Published: March 2016

In 1841 Dr Samuel Hitch organised a meeting at Gloucester Lunatic Asylum during which a decision was taken to establish the Association of Medical Officers of Asylums and Hospitals for the Insane with a view to “improvement in the management of such institutions and the treatment of the insane, and the acquirement of a more extensive and more correct knowledge of insanity”. From the six medical officers present at this historic meeting the membership of The Royal College of Psychiatrists has grown to more than 11,000, of whom over 1,500 practise overseas. Dr Mike Shooter (President) believes that the College's most important, and painful, transformation has been from a largely educational to a political organisation.
Learning disability among referrals to a community child psychiatric service
Authors: Clarke Ciaran S , Houlihan Brian
Published: March 2016

Objectives:We sought to determine the frequency of learning disability (IQ > 70) among referrals over a period of six years to a community child psychiatric service in a socially disadvantaged area of Dublin.

Methods:We investigated the gender and age characteristics, as well as the frequency of speech and language, emotional, and behavioural problems in this group. We tried to determine what educational help each child was receiving at the time of referral.

Results:Sixty-five of 942 patients referred to the clinic had a mild (60) or moderate (five) learning disability. Forty-eight patients were male and 17 were female. The mean age at referral was 10.5 years, and there was no gender difference. All were referred because of educational problems. Behavioural disorders were present in 31, emotional disorders in 13 and speech and language disorders in 37. Six had suffered some form of abuse, mostly emotional. Five had problems with concentration or markedly impulsive behaviour. At the time of referral, 10 were in special schools, seven were in special classes in normal schools, and nine had a special resource teacher. Adequate educational support was not being adequately provided for 33 at the time of psychiatric referral.

Conclusions:Learning disability occurs in 7% of children referred to the child psychiatry clinic of a disadvantaged urban community and, while this may reflect the late onset of psycho-social and educational problems in such children, these findings give cause for concern that delayed referral may exacerbate their and their families' problems. The educational needs of most of the children were not being addressed. Reasons for these findings are discussed.
Neuropsychiatric complications of corticosteroids in older people
Authors: Freyne Aideen
Published: March 2016

The neuropsychiatric effects of corticosteroids are well described in the literature but relatively little is known specifically about their effects among older people. As the population ages, and increasing numbers of older people receive assertive medical treatment for physical conditions, more patients are likely to present to psychiatric services suffering from adverse neuropsychiatric effects associated with corticosteroid use. A review of the effects of corticosteroids among older people was carried out through Medline and PubMed searches and a review of article references. Very little has been specifically written about steroid use and the effects on older people. This paper briefly outlines the current level of knowledge of neuropsychiatric effects of steroids, and relates this to general treatment considerations for older subjects. Recommendations for further research and early identification of complications are made.
Of the Right and Left Hand (1646):Sir Thomas Browne's historical survey of ‘handedness”
Authors: Breathnach Caoimhghin S
Published: March 2016

‘Handedness’ as an expression of cerebral lateralisation is valuable in analysis of hemispheric asymmetries, carrying implications for implementation (as well as interpretation) of complex cognitive functions. In recent decades it has become possible to categorise handedness in a reproducible manner and, independently, to estimate accurately the degree of language lateralisation of the brain. These advances have re-focussed attention on cerebral organisation and hemispheric asymmetries, and there is now considerable interest in the neuropsychology of left-handedness. Because of procedural and ethical constraints there are relatively few large scale studies on language dominance, whereas handedness has been studied extensively in recent decades. Language is represented in the left hemisphere in all but 1% of right-handers, and in 60% of left-handers; in 15% of right-handers speech representation was bilateral.

Precise determination of handedness or lateralisation does not appear to have been assessed in major studies of electroconvulsive therapy (ECT). Results in 29 reports, when the electrodes were placed over either the non-dominant or both hemispheres, were tabulated and briefly discussed by d'Elia and Raotma, but the criterion of lateral dominance assignment was not clearly specified; the unilateral and bilateral placements were equally efficacious in their antidepressant effect. d'Elia, who introduced unilateral therapy in 1970, accepted the assumption that the left hemisphere was ‘dominant’, but later workers were more circumspect.
Physical sciences and psychological medicine: the legacy of Prof John Dunne
Authors: Kelly Brendan D
Published: March 2016

Fifty years ago, on July 13, 1955, Professor John Dunne delivered his presidential address to the annual meeting of the Royal Medico-Psychological Association in Dublin, focussing on the contributions of ‘the physical sciences to psychological medicine.’ In his address, Professor Dunne discussed (a) the principle of conditioning, and the work of Hans Selye, especially in relation to ‘General Adaptation Syndrome’ and the role of stress in producing psychosomatic symptoms; (b) cybernetics and the generation of partial models of cerebral functioning, such as Grey Walter's Conditioned Reflex Analogue and the Electronic Delayed Storage Automatic Computer of Cambridge and (c) the development of integrated, holistic models of cerebral functioning, that took account of advances in both physical medicine and psychoanalytic thought. Professor Dunne placed particular emphasis on the importance of basic scientific research and the development of broadly based models of psychiatric care, both of which were to play critical roles in the development of more scientifically-based, bio-psycho-social models of service provision in the decades to follow.
Mental health in general practice: assessment of current state and future needs
Authors: Copty Mimi , Whitford David L
Published: March 2016

Objectives: To determine the extent of mental health services provided in the community in one Irish health board area. To examine the influence of postgraduate mental health training of GPs on provision of mental health services.

Method: Questionnaire and focus group methods were employed to determine views on mental health service provision. Data analysis was with parametric and non-parametric tests of association including student's t and chi-squared tests. Thematic analysis of the focus groups was carried out.

Results: Twenty-five per cent of patients attending general practice have mental health problems and over 95% of these problems are dealt with in primary care. Only 32% of GPs had received postgraduate training in psychological therapies. GPs with postgraduate training in psychological therapies were more likely to estimate a higher proportion of their patient population with mental health problems and less likely to refer to psychiatric services. A need for support from other health care professionals in primary care was also identified.

Conclusion: The majority of patients with mental health problems are treated in primary care. Further training of GPs and increased resources would improve mental health care in primary care and lead to fewer referrals to psychiatric services.
Atypical antipsychotic monitoring in the Kilkenny Mental Health Services
Authors: Feeney Larkin , Mooney Mary
Published: March 2016

Objectives:To examine baseline testing and ongoing monitoring of cardiovascular and other risk factors in individuals prescribed atypical antipsychotic medications.

Methods:We derived a list of baseline and ongoing monitoring tests from the literature (Weight, BMI, blood pressure, U&E, LFTs, glucose, HbA1C, FBC, TFTs, prolactin, lipids & ECG) and then reviewed a random sample of 80 records of patients prescribed atypical antipsychotics and currently attending an Irish public catchment area service, for evidence of testing.

Results:Levels of testing for baseline tests ranged from 45% for blood pressure to 0% for BMI. Levels of ongoing monitoring tests ranged from 42.5% for U&E to 0% for BMI. Patients admitted to hospital were much more likely to have had testing.

Conclusions:The need for baseline and ongoing monitoring of certain tests in patients prescribed atypical antipsychotics is increasingly accepted. Levels of such testing are currently quite low and need to increase.
Psychiatric morbidity among women prisoners newly committed and amongst remanded and sentenced women in the Irish prison system
Authors: Wright Brenda , Duffy Dearbhia , Curtin Katherine , Linehan Sally , Monks Stephen , Kennedy Harry G
Published: March 2016

Objectives: To estimate the prevalence of psychiatric morbidity, substance misuse problems and related health and social problems among women prisoners newly committed and a cross-section remanded and sentenced in the Irish prison population. In 2002 women represented 10.7% (1043) of all persons committed to the Irish Prison system, and 3.3% (104) of the daily average number of persons in custody. We surveyed psychiatric morbidity in these two groups to assess the need for psychiatric services for women prisoners, and to compare Irish morbidity with an international average.

Method: We interviewed 94 newly committed women prisoners within 72 hours of committal, representing approximately 9% of female committals per year. We also interviewed a cross sectional sample of 92 women, representing approximately 90% of all women in custody. Mental illness and substance misuse was measured using the SADS-L, SODQ and a structured interview.

Results: Five (5.4%) of the committal and 5 (5.4%) of the cross-sectional sample had a psychotic illness within the previous six months. 8 (8.5%) of the committals and 15 (16.3%) of the women in the cross-sectional sample had a major depressive disorder in the last six months. 8 (8.6%) committals and 14 (15.2%) in the cross-sectional sample had an anxiety disorder within the last six months. 61 (65.6%) of the women interviewed at committal and 61 (65.2%) of the cross-sectional sample had a substance misuse problem in the last six months.

Conclusions: There is a high prevalence of mental illness and substance misuse problems amongst women newly committed to prison and in a cross section of those remanded or sentenced in prison in Ireland. We found evidence of a cycle of deprivation and institutionalisation. These findings highlight the need for the integration of community and forensic psychiatric services, and for ongoing collaboration with drug services.
Choreoathetosis, an unusual presentation of serotonin syndrome
Authors: Hodnett Phillip , Renganathan Radhakrishnan , Fitzgerald Patricia , Roderick Gaivin
Published: March 2016

We describe a 63 year old male with serotonin syndrome, presenting with choreoathetosis. Differentiating this syndrome from neuroleptic malignant syndrome remains a challenge. It is important to be aware of drugs that can potentially precipitate this syndrome.
The assessment of need in patients presenting to psychiatrists in the general hospital
Authors: Feeney Larkin , Kavanagh Annette , Mooney Mary , Browne Stephen
Published: March 2016

Objective: The evaluation of psychosocial need is an important part of the assessment of any patient who presents to a psychiatrist. The Camberwell Assessment of Need (CAN) instrument was developed for the systematic assessment of need in people with severe and enduring mental illness. Variations of the CAN have been developed for forensic, elderly and learning disability populations. Patients presenting to psychiatrists in the general hospital may also have different needs to those presenting to psychiatrists in other settings. We set out to examine whether the CAN would be useful in identifying needs in patients referred to psychiatrists in the general hospital with self-harm or alcohol problems.

Method: Over a four-month period from September 2004 we prospectively assessed all patients with self-harm or alcohol problems referred to a liaison psychiatry service. We used the short version of the Camberwell Assessment of Need instrument (CANSAS) to assess psychosocial needs. Urgent referrals to a local psychiatric service of patients with severe enduring mental illness (SEMI) were assessed using identical methodology over the same time period and used as a comparison group.

Results: Over the study period 53 patients with self-harm, 42 with alcohol problems and 45 with SEMI were assessed. Patients presenting with self-harm and alcohol problems had significantly fewer needs than those with SEMI (4.40 vs 3.98 vs 7.96, p < 0.001). Looking after the home, self-care, daytime activity, psychotic symptoms, safety to others and sexual expression needs were significantly greater in the SEMI group than in either the DSH or alcohol groups. Only safety to self-needs in the DSH group and alcohol needs in the alcohol group were significantly higher than in the SEMI group. The proportion of needs that were unmet was similar in each group.

Conclusions: The CANSAS instrument identified some needs in deliberate self-harm and alcohol problem patients that might not have been identified during the course of a standard psychosocial assessment. It was easy to administer and as such was a useful addition to the assessment process. However the development of a more specific instrument for the assessment of need in these populations would be useful.
Views of family carers to the future accommodation and support needs of their relatives with intellectual disabilities
Authors: McConkey Roy , McConaghie Jayne , Barr Owen , Roberts Paul
Published: March 2016

Objectives:The demand for places in supported accommodation is likely to rise due to the increasing longevity of people with intellectual disabilities and as their parents become unavailable or unable to care for them. However few attempts have been made to ascertain carer's views on alternative accommodation.

Method:Four studies were undertaken in Northern Ireland to ascertain carer's views using three different methods. In all, 387 carers participated with the response being greatest for individual interviews conducted in the family home and least for self-completed questionnaires and attendance at group meetings.

Results:The majority of carers envisaged the person continuing to be cared for within the family. The most commonly chosen out-of-home provision was in residential or nursing homes, living with support in a house of their own and in homes for small groups of people. Few carers chose living with another family. However only small numbers of carers envisaged alternative provision being needed in the next two years and few had made any plans for alternative living arrangements.

Conclusions:The implications for service planning are noted, primarily the need for individual reviews of future needs through person-centred planning; improved information to carers about various residential options and their differential benefits, along with more services aimed at improving the quality of life of people living with family carers. These need to be underpinned by a commitment of statutory agencies to partnership working with family carers. The implications for mental health services are noted.
Older people with enduring or recurrent severe mental illness in the Eastern Region of Ireland
Authors: Wrigley Margo , Murphy Bernadette , Farrell Martin , Cassidy Brendan , Ryan Jim
Published: March 2016

Objectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.

Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.

Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)

Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.
Older people with enduring or recurrent severe mental illness (graduates): A literature review
Authors: Wrigley Margo , Murphy Bernadette , Farrell Martin , Cassidy Brendan , Ryan Jim
Published: March 2016

Objectives: To review the literature on older people with enduring or recurrent severe mental illness with an onset earlier than 65 years (graduates) and, in particular, to look at the specific features and needs of this group.

Method: A Medline literature search produced 41 relevant papers and reports on the subject.

Results: There are a substantial number of older people with severe mental illness and the number will rise in line with increased longevity. As they age these patients' psychiatric disabilities are compounded by medical and social problems. The move to community based care has largely ignored the needs of graduates who were previously cared for in psychiatric institutions.

Conclusion: There is an urgent need to plan and develop adequate services for this vulnerable group.
High prevalence of risk factors for physical illness in a long-stay psychiatric unit
Authors: O'Brien Sinead , Devitt Enda , Ahmed Mohamed , McDonald Colm
Published: March 2016

Objective: The aim of this study was to determine the prevalence of risk factors for physical illness in a long stay psychiatric unit, where all care (both psychiatric and physical) is provided by the psychiatric team.

Method: All patients in the long-stay ward had a full physical examination including calculation of BMI. All patients had blood sampling including FBC, U&E, LFTs, TFTs, lipid profile (total cholesterol, triglycerides, HDL and LDL), glucose, HbA1c, and prolactin. ATP111 criteria were used to determine the presence of the metabolic syndrome.

Results: We found the mean number of comorbid medical diagnosis was 2.7. The prevalence of metabolic syndrome was 40.7% (44.4% of females and 24.1% of males). The prevalence of obesity was 51%, and 51% also had a total cholesterols in excess of 5.0mmol/l. Prolactin was elevated in two-thirds of female patients.

Conclusion: We conclude that the annual physical examination is of limited value in long-stay psychiatric unit. The high prevalence of physical illness and physical risk factors warrants primary care involvement in screening and treatment of long-stay psychiatric patients.
Point prevalence of diabetes, obesity, hyperlipidaemia, hypertension and smoking in outpatients on clozapine
Authors: Feeney Larkin , Kelly Fiona , Lee Judy , Kelly Elizabeth , McLaughlin Sheila , O'Boyle James H
Published: March 2016

Objectives: Patients with schizophrenia are known to be at higher risk than the general population of cardiovascular disease. Clozapine has been associated in the literature with high levels of cardiovascular risk factors such as weight gain, diabetes, hyperlipidaemia and hypertension. We set out to determine the prevalence of these risk factors in a population of Irish psychiatric patients.

Method: In February 2006 we measured body mass index, fasting blood glucose, haemoglobin A1c (HbA1c), lipid levels, mean blood pressure and smoking rates among all outpatients prescribed clozapine attending an urban, community based mental health service.

Results: There were 50 outpatients (33 male; 17 female) on clozapine and they had been taking it for a mean of 5.4 years (mean daily dose 428.8mg). The mean body mass index was 28.3. Patients had gained a mean of 8kg since commencing clozapine. One patient had been diagnosed with diabetes. Of the other 49 none met diagnostic criteria for diabetes. The mean fasting blood glucose was 5.5mmol/l and the mean HbA1c was 5.7%. One patient was on treatment for hyperlipidaemia. The mean fasting cholesterol among the other 49 patients was 5.4mmol/l, while the mean fasting triglycerides was 2.1 mmol/l. Thirty (61.2%) had a fasting cholesterol greater than 5.0mmol/l, while 18 (36.7%) had triglycerides of greater than 2.0mmol/l. Three patients were on treatment for hypertension. Thirty-six of the 50 (72%) smoked (mean 13 cigarettes per day).

Conclusions: The prevalence of obesity, diabetes, hyperlipidaemia and hypertension in this population was high but lower than might have been expected from US studies. It is important that cardiovascular risk factors are closely monitored and actively addressed in this at risk population.
First admissions to inpatient care in Ireland for schizophrenia 1971-2004: trends in gender and age
Authors: Hart Caroline , Doherty Donna T , Walsh Dermot
Published: March 2016

First admissions for schizophrenia to inpatient psychiatric services in Ireland are declining. The reason for this decline has been debated and it has been proposed that it could be attributable to either a decline in incidence or to policy changes or to both.

Objectives:This study examines the trends in first admission numbers for schizophrenia in Ireland and the influence of gender and marital status on age at first admission over the time period 1971-2004.

Method:Data were derived from the National Psychiatric Inpatient Recording System (NPIRS) for the years 1971-2004 inclusive. All first admissions with a diagnosis of schizophrenia during these years were included in the analysis.

Results:The results showed a significant decline in the number of first admissions with the number of first admissions for males exceeding those for females. The average age of first admission was higher for females than males (p < 0.001). The average age of first admission showed a decline for males (p < 0.001), but not for females. Marital status was a stronger predictor of age of admission than gender (p < 0.001). Never married persons had a lower age of first admission than those married and the delaying effect of marriage on age at first admission was evident in males and females (p < 0.001).

Conclusions:An examination of first admission hospital data confirm male disadvantage in schizophrenia. The study highlighted a number of areas for future research which include examining gender differences in more refined diagnostic sub groups of schizophrenia and the monitoring of first contacts with community-based mental health services.
Depression and cardiovascular disease: does antidepressant treatment improve cardiac outcome?
Authors: Gallagher Damien
Published: March 2016

Objective: The association between depression and cardiovascular disease has been well documented but the nature of this relationship continues to be defined. Given the accumulation of epidemiological evidence linking these diseases a number of interventional studies have been undertaken to assess the issue of whether antidepressant treatment in depressed patients with cardiovascular disease improves cardiac outcome. The objective of this paper is to review recent randomised controlled trials on this topic and to explore the implications that these may have for future research in this area.

Method: This review is derived from a MEDLINE search using the search terms ‘depressive disorder’ and ‘cardiovascular diseases’. Only randomised controlled trials published in English with clearly defined methods and interventions are included here. Reference sections from the articles were used to identify additional relevant studies.

Results: A small number of high quality trials were uncovered which indicated mixed results in terms of the treatment of depression in cardiovascular disease. None indicated a statistically significant difference in cardiac outcome.

Conclusions: It is not possible at this time to recommend treatment for depression to reduce cardiovascular risk. However depression remains prevalent in patients with cardiovascular disease and is a treatable cause of morbidity in its own right.
Globus pallidus deep brain stimulators for a case of severe neuroleptic-related dystonia and dyskinesia
Authors: McWilliams Stephen , Pennington Nick de , Aziz Tipu Z , Brophy Justin
Published: March 2016

We report a 45 year old man with neuroleptic-induced dyskinesia for whom deep brain stimulators (DBS) were implanted in the globus pallidus internus (GPi). We describe a significant improvement in his symptoms. Lastly, we review briefly the success of deep brain stimulation to date, and discuss the clinical implications for individuals who develop movement disorders during neuroleptic use.
A ‘silent’ political protest by an asylum seeker presenting to an Irish psychiatric service
Authors: Browne David J , Rohllia Haseeb , Gannon Miriam
Published: March 2016

We report a case of a male asylum seeker, protesting politically, who stitched his lips together, presenting to a psychiatric service for assessment. We review the literature in this area. Funding of psychiatric services to meet the complex needs of immigrants should be an integral part of service development.
Empowerment, quality of life and service satisfaction: comparisons between a hospital and community placement group
Authors: Kerrigan Keith , Davidson Gavin , Shannon Ciaran
Published: March 2016

Objectives: Recent advances in mental healthcare policy and service delivery have lead to the development of community care initiatives which have enabled those individuals traditionally cared for in hospital environments to be resettled successfully in community living arrangements that foster an ethos of empowerment and recovery. This study sought to identify differences between a hospital continuing care group (n = 16) and a community placement group (n = 20) in relation to quality of life, satisfaction and levels of empowerment.

Method: The study was a cross-sectional design. It follows up a cohort of individuals identified as the ‘hospital continuing care group’ (365+ consecutive days in psychiatric hospital care) by Homefirst Community Trust in Northern Ireland. A proportion of this population has been resettled into community care environments and some continue to reside in hospital. Patients both in the hospital continuing care group and the community placement group completed two standard questionnaires that covered a number of variables including empowerment, quality of life and service satisfaction.

Results: There were significant differences between the hospital continuing care and community placement groups across scores on service satisfaction, quality of life, and empowerment in the current study. Hypotheses relating to service satisfaction (z = −4.117; p < 0.01 ), quality of life (z = −3.944; p < 0.01) and empowerment (z = −4.645; p < 0.01) were supported with higher levels of each evidenced by the community placement group.

Conclusions: The results are supportive of continued resettlement from continuing care in traditional psychiatric hospitals and suggests that such resettlement increases quality of life, satisfaction with services and levels of empowerment. The limitations of the research design are empowerment. The limitations of the research design are also discussed.
Ireland's long-stay charge refunds: mental capacity and dilemmas in a psychiatric institution
Authors: Kavanagh Annette , Browne Stephen , Horgan Richard , O'Sullivan Derek , Sheppard Noel , Kirby Michael
Published: March 2016

Objective: All patients who resided in state provided long-stay care in Ireland were required to pay the state for that care until 2006. In 2001 the Irish Ombudsman and Information Commissioner had highlighted the issue of the entitlement of people with medical cards to provision of free long-stay care. The Health Repayment scheme was subsequently set up in 2006 to facilitate the repayment of long-stay charges wrongly paid by patients. Issues of mental capacity arise particularly in the context of long-stay psychiatric patients applying for repayment of long-stay charges. Our aim was to devise a test suitable to assess the capacity of an individual to make an application for refund charges.

Method: There was no specific test in existence to assess the capacity of an individual to make an application for refund of charges. A suitable test was devised based on the available literature which assessed whether the person understands the ‘nature and effects’ of making a refund application. Fifty-eight long-stay patients were deemed to be entitled to apply for a refund.

Results: Staff identified 47 (80%) patients as possibly lacking the capacity to make an application. Of these, 14 patients (29.8%) were found to have capacity to make an application (mean age 58.5 years) with 33 (70.2%) found to lack capacity (mean age 73 years). Of those with capacity 50% had a diagnosis of schizophrenia/schizoaffective disorder. None had cognitive impairment of degenerative origin. Of those who lacked capacity 45.5% had a diagnosis of dementia. All of the patients with dementia who were assessed were found to lack capacity whereas 59% of those with a diagnosis of schizophrenia/schizoaffective disorder lacked capacity.

Conclusion: A substantial number of long-stay psychiatric patients may lack the capacity to make particular decisions. In this study the group who lacked capacity were an elderly group with dementia common. This process raised a dilemma about how a patient without capacity to make a refund application can then manage the money claimed on their behalf and whether guardianship safeguards are necessary.