bluuebunny/crossref_metadata_2025_split huggingface dataset:
Electroconvulsive therapy: International guidelines, clinical governance and patient selection
Authors: Rush Gavin , Kimmich Okka , Lucey James V 
Published: March 2016

AbstractRecent 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

AbstractThe 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

AbstractObjectives: 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

AbstractObjectives: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

AbstractWe 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

AbstractObjectives: 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

AbstractMethadone 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

AbstractObjectives: 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

AbstractObjectives: 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

AbstractWe 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

AbstractObjectives: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

AbstractObjective: 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

AbstractObjectives: 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

AbstractObjectives: 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.