bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes of consultants to prescribing ECT for patients involuntarily admitted under MHA 2001
Authors: Schirliu Diana , Truszkowska Edyta , McDonald Colm 
Published: March 2016

AbstractObjectives: The Mental Health Act (MHA) 2001 provides the legislative structure in Ireland for the involuntary admission and treatment, including with ECT, of patients suffering from mental disorders. A recent Seanad Bill proposed removing the option of administering ECT to involuntary patients who do not provide informed consent. This controversial issue has stimulated extensive media and stakeholder debate. In this study we explored the attitudes of consultant psychiatrists towards prescribing ECT for involuntary patients.Methods: We compiled a current list of consultant psychiatrists attached to approved centres nationwide. We sent a study specific questionnaire to consultants of all adult psychiatry specialties.Results: From the 249 individualised anonymous questionnaires posted, 164 (66%) were returned and analysed. When clinically indicated for involuntary patients willing to consent to ECT treatment, 159 (97%) consultants stated that they would and three (2%) would not prescribe ECT. For involuntary patients who lack capacity and are unable to consent, 157 (96%) consultant psychiatrists stated that they would and six (4%) that they would not prescribe ECT. For involuntary patients who have capacity to consent but are unwilling to do so, 52 (32%) consultant psychiatrists stated they would and 104 (63%) would not prescribe ECT.Conclusions: The overwhelming majority of consultant psychiatrists would prescribe ECT for involuntary patients who are unable to consent to this treatment. Divergent attitudes emerged for treating patients who are unwilling to consent, with most consultant psychiatrists stating they would not prescribe ECT for this patient group.
Prevalence of substance misuse comorbidity in an Irish university training hospital
Authors: Dixit Ajay , Payne Ann 
Published: March 2016

AbstractObjective: Substance misuse complicates an individual's management in adult Mental Health services. This study aimed to examine both the overall prevalence of substance misuse in those admitted to the psychiatric unit and additionally those admitted with a primary diagnosis and comorbid substance misuse. The study focuses on the associated diagnoses and demographics in 100 consecutive admissions to an acute psychiatric unit in an Irish university hospital.Method: Clinical notes were reviewed independently by two members (one being a doctor), of the multi-professional research team within four days of their admission. Substance misuse proximal to the/at the time of admission (reflecting the current usage) was noted.Results: The combined prevalence of mental illness and substance misuse was 47% (CI 37-57%). Twenty two out of 100 (22%, CI 14-32%) were admitted primarily for the management of substance misuse and dependence (plus psychosocial reasons). Twenty-five of the patients admitted with a primary psychiatric illness (25%, CI 17-31%) were discovered to have comorbid substance misuse. At risk groups were found to be males and aged under 45 years.Conclusion: Our study demonstrates the importance of screening and identification for substance misuse in psychiatric inpatient units; and consequently, the need for individual case management, additional development of dual diagnosis services and accurate patient data reporting to facilitate forward service-planning.
Audit of documentation of allergies in a psychiatric inpatient unit
Authors: Eneh Oliaku , Fahy Sabina 
Published: March 2016

AbstractObjectives: This audit aimed to: identify the level of allergy documentation in admission notes, case notes and medication charts in the Department of Psychiatry, Portlaoise; establish the degree of compliance to the gold standard guidelines; highlight areas requiring further improvement and make realistic recommendations to ensure better compliance with the stipulated guidelines on allergy documentation; and re-audit after six months.Methods: Gold standard guidelines on allergy documentation were obtained from various sources. Audit was performed over three days during which data was collected from the allergy section of medication charts, current case notes and original admission notes in both acute and long-stay wards. Recommendations were made and some were adopted, changes to practice were implemented for six months; at which time re-audit was performed.Results: The initial audit revealed that: the allergy section was completed in 25% of medication charts; only 12% of current case notes had any documentation of allergy status; an for the original admission notes, the allergy section was documented in 65% of notes. Based on these results, a formal initial assessment proforma with a designated allergy section was introduced and a renewed awareness of the importance of the documentation of allergy status was actively promoted amongst non consultant hospital doctors (NCHDs). Six months later, re-audit showed that: in the medication charts there was a significant improvement in the level of compliance with documentation of allergy status (allergy or NKDA) in the allergy section up from 25% to 58.1%; in the current case notes, there was only marginal improvement in the level of compliance on the front of case notes from 12-19.1%; and in the original admission notes, there was also considerable improvement in the level of compliance with documentation of allergy status up from 65% to 80.9%.Conclusion: This audit improved the level of documentation of allergy sections in the relevant areas and therefore helped in preventing avoidable and potentially fatal allergic reactions. It will also help save money for the Health Service Executive by reducing compensation costs filed by patients.
Cognitive remediation therapy for schizophrenia: what is it and does it work?
Authors: Donohoe Gary , Schmidt Heike , Robertson Ian H 
Published: March 2016

AbstractImpaired cognition is a core feature of schizophrenia (SZ) that precedes, accompanies, and often outlasts a patient's clinical symptoms. The success of new generation antipsychotics, as well as their failure to ameliorate the persistent disabilities associated with the disorder are well documented. Consequently, a number of psychosocial and cognitive interventions have been developed to address specific aspects of disability not adequately alleviated by medication.Among these, interventions adapted from the acquired brain literature that target cognitively based disability (cognitive remediation therapy; CRT) have received significant empirical support both for ameliorating specific deficits in memory, attention and executive function, and improving real world outcome. CRT strategies have focused either on providing drill-based training aimed at increasing capacity or providing behavioural strategies for compensating for cognitive deficits, or a mixture of both. Nonetheless, these interventions have varied widely and several questions remain.This review provides a brief overview of cognitive remediation therapies in psychosis, discusses evidence for its success, and outlines a number of questions that remain about its implementation. Given the current unavailability of cognitive remediation as part of standard care in Irish mental health services, we conclude by describing one such intervention developed within our clinical research group and the questions we hope to address in making this programme more widely available to Irish patients.
Anxiety and depression among opiate users who misuse substances during treatment
Authors: Stapleton Robert , Comiskey Catherine 
Published: March 2016

AbstractObjectives: While treatment is known to improve drug and crime outcomes for opiate users, there is debate in the literature about the longitudinal effects of substance misuse and the comorbidity of mental health problems. We sought to describe and model anxiety and depression outcomes during opiate substance misuse treatment.Methods: The first national, longitudinal treatment outcome study of 404 opiate users entering a new episode of inpatient or outpatient treatment and followed up at one and three years and assessed using the Maudsley Addiction Profile instrument.Results: A total of 404 opiate users were recruited representing approximately 8.2% of all new treatments and 17% of all new methadone treatments at national level in Ireland in 2003. At three years 97% (n = 392) were followed-up. At one year, analysis revealed the odds of experiencing depression was between five and 15 times the odds for opiate users who also used cocaine than non cocaine using opiate users, but this had decreased at three years. At three years those who were drug free, that is, not in treatment and not using illicit drugs, were less likely to experience feeling hopeless about the future than those in treatment or those not in treatment and using, but they were also more likely to experience feeling tense. Those in treatment were more likely to feel lonely.Conclusion: The concurrent misuse of cocaine and other substances during opiate treatment and the stage of the treatment pathway are associated with anxiety and depression among opiate users in treatment. These client factors need to be considered when implementing individualised treatment care plans.
Users' experiences of cathinones sold in head shops and online
Authors: O'Reilly Fiona , McAuliffe Ruardhi , Long Jean 
Published: March 2016

AbstractObjective: We describe use and effects of head shop powders among opiate dependant polydrug users and recreational drug users. These powders contain cathinones and were sold as bath salts or plant food via the internet or in head shops.Method: As this is a relatively new phenomenon, a qualitative approach using three data sources, in-depth interviews, a focus group (containing 10 opiate users) and a head shop website containing 49 product reviews, was employed. Themes were identified.Results: According to the study population, these powders mimic the effects of cocaine, ecstasy and amphetamines. These substances were snorted, ingested or injected by people and were not used as bath salts or plant food. The users' experience indicates that these powders have the potential for dependence, and exhibit side effects such as insomnia, anxiety and other mental health effects. The users report that the effects of the substances vary over time indicating that the chemical contents of the powders may change.Conclusion: Though users' descriptions of effects varied, there were indications of health and dependency effects which were more severe and more common among problematic opiate users, who also experienced increased social vulnerability. In general the recreational drug users considered their side effects to be mild and worth the drug induced experience.
Counter-urbanisation during Ireland's ‘Celtic Tiger’ period – mental health implications
Authors: Owoeye Olabisi , Khawaja Manzar , Kinsella Anthony , Russell Vincent 
Published: March 2016

AbstractObjectives: This study (a) describes the clinical and demographic profile of urban to rural migrants attending a psychiatric outpatient clinic and (b) explores the impact of the move on patients' mental health and lifestyle.Methods: A self-rated questionnaire distributed to 207 consecutive outpatients requested demographic and clinical information from migrant and non-migrant patients. A focus group study among a purposeful sample of 10 migrant patients explored participants perceptions of the move and its impact on mental health.Results: One hundred and one patients (48.8%) returned the questionnaire. Most migrant responders described housing affordability as influencing their decision and were generally satisfied with the move. However, half reported reduced access to social amenities. Over half of the migrant outpatients had a previous psychiatric history and were mostly unemployed despite being home-owners. Predominant focus group themes included the perceived need to leave the city for the relative safety and calm of rural living as well as post-migration concerns regarding future isolation and diminished levels of support.Conclusion: Clinicians and service providers in rural areas should be informed by an awareness of the potential mental health implications of counter-urbanisation.
Sharing control: user involvement in general practice based methadone maintenance
Authors: O'Reilly Fiona , O'Connell David , O'Carroll Austin , Whitford David L , Long Jean 
Published: March 2016

AbstractObjectives: This study assessed patients' views of a methadone programme in a Dublin general practice including the degree to which the patients were ‘involved in decisions about their treatment’.Method: All patients receiving methadone were asked to participate. A face to face questionnaire, with open and closed questions, was administered. Interviews lasted approximately 30 minutes. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using a thematic approach.Results: Forty one (87%) of the 47 patients attending the general practice methadone service were interviewed. Of the 39 patients who had used heroin on admission, 69% had stopped and 31% reduced heroin use since starting methadone treatment. A total of 71% reported that the doctor either always involved (59%) or sometimes involved (12%) them in decisions about their treatment. Involvement was interpreted as ‘being listened to’ or ‘having a say’ in deciding methadone dose. Surprisingly those who reported that they were not involved in treatment decisions were more likely to have stopped heroin use (10/11). A significant majority of patients (81%) expressed the desire to stop taking methadone.Conclusion: Most patients receiving methadone in general practice were listened to and had a say in deciding their methadone dose but did not have an opportunity to engage in more structured or contractual forms of involvement in treatment such as written care plans. In line with a patient centred approach, treatment providers should set their sights beyond the safe delivery of methadone, to provide a service which is centred on patient goals, expectations and choice.
Communication between community mental health services and primary care
Authors: Agyapong Vincent IO , Ahmodu Olorunfemi , Guerandel Allys 
Published: March 2016

AbstractObjectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.
Recovery from mental illness: changing the focus of mental health services
Authors: Oshodi Abiola , Rush Gavin 
Published: March 2016

AbstractThe concept of recovery entered the lexicon of the mental health services in the 1980s following the publication of a series of studies and personal narratives which demonstrated that the course of mental illness was not always one of inevitable deterioration and that people diagnosed with severe mental illness could reclaim or recover meaningful lives. For a long time, recovery was not thought possible by many family members, service providers and researchers. However globally, specific policy and clinical strategies are being developed to implement recovery principles although key questions remain. In fact, the possibility of recovery is still debated by some. In this paper, we include information about the recovery model and the medical model; we provide evidence for recovery and document changes in mental health practices and policies incorporating recovery as the guiding principle. We also attempt to address the debate as to whether recovery is an evidence based practice. We propose that evidence based practice should be complementary to value-based and narrative-based practices and we suggest an integrative model that maximises the virtues and minimises the weaknesses of each practices (see Figure 1).
Sexual dysfunction and antidepressants: a review with emphasis on treatment
Authors: Kenny Maeve , Jabbar Faraz 
Published: March 2016

AbstractSexual dysfunction (SD) is widely recognised as a potential side-effect of antidepressant therapy. SD has been reported with all classes of antidepressants (MAOIs, TCAs, SSRIs, SNRIs and newer antidepressants) in patients with depression and anxiety disorders. Increased attention has been directed at the SD produced by antidepressants; not only because its initial prevalence was underestimated but also because of the adverse impact that these side-effects can have on treatment compliance. Although SD is an important adverse effect of antidepressant medication, patients tend to be reluctant to report them if not directly questioned. This suggests that consideration of the doctor-patient relationship is needed when deciding on an appropriate treatment plan.
Hypogonadism in an opioid dependent man
Authors: Nkire Nnamdi , Doran Michael , O'Connor John J 
Published: March 2016

AbstractWe describe here the case of a 45-year-old man with a chronic history of heroin abuse who has received methadone maintenance therapy for 12 years. At admission, on this occasion, for stabilisation on methadone, he reported a two-year history of painful gynaecomastia and testicular atrophy. Investigations revealed abnormal sex hormone levels. Liver function tests, thyroid function tests, Brain (pituitary) MRI and viral screens were normal. Following assessment and abnormality in two morning total testosterone level measurements he was diagnosed with hypogonadism secondary to opioid use. Although he had a previous history of alcohol abuse, he was abstinent from alcohol use for five years at time of assessment. He was commenced on parenteral testosterone replacement with therapeutic benefit.In light of the increased use of opioids, it is important to recognise and manage the endocrine complications of opioid use. The need for an empathic and adequate sexual history, physical examination and investigation is essential in patients who use opioids to ensure that cases of hormonal dysfunction are detected early and managed appropriately.
Clinical evaluation of carbohydrate deficient transferrin as an indicator of alcohol dependence
Authors: Naik Prakash C , Webb Tim , McLean Phillip C 
Published: March 2016

AbstractObjective:To evaluate the clinical usefulness of carbohydrate deficient transferrin (CDT) as an indicator of alcohol dependence (DSM 111R).Method:Subjects included 18 patients with alcohol dependence and 36 controls (15 recovering alcohol dependents and 21 blood donors). Blood samples from the subjects were analysed for CDT, mean corpuscular volume (MCV) and γ Glutamyltransferase (γGT). These indicators were compared for their sensitivities and specificities to detect excessive alcohol use.Results:Amongst patients with alcohol dependence, CDT was detected in all (100%), γGT was raised in 8 (44%) and MCV was raised in 4 (22%). CDT was detected in five of the 36 controls.Conclusion:CDT was the most sensitive indicator of alcohol dependence. However, CDT showed a much higher false positive rate compared to previous studies. More research is required to elicit at what level of alcohol consumption CDT becomes positive. CDT could prove to be a clinically useful indicator of excessive alcohol use in future.
Psychosis and recreational use of MDMA (“Ecstasy”)
Authors: Keenan Eamon , Gervin Maurice , Dorman Arthur , O'Connor John J 
Published: March 2016

AbstractA seventeen year old man attended the National Drug Treatment Centre with a paranoid psychosis following ingestion of Methylene dioxy methamphetamine (MDMA). He had been taking MDMA on a recreational basis over a five month period. Although chronic psychosis after heavy use of MDMA has been reported there are no pervious reports of psychosis following recreational use. This report highlights the psychological dangers of this drug, which has become widely misused in Dublin over the last two years.
Bipolar disorder patients' attitudes to and knowledge of their illness: a retrospective study
Authors: McKeon Patrick , O'Loughlin Fionnuala 
Published: March 2016

AbstractObjective: To assess the effect of specific psychoeducational sources – support group meetings, lectures and literature – on bipolar disorder patients' knowledge and attitude to their illness. Methods: Eighty bipolar disorder patients attending for a lithium blood test were asked to complete a questionnaire detailing their demographic characteristics, duration of illness, knowledge of manic-depressive illness and their attitude towards their illness and what exposure they had had to relevant support group meetings, lectures and literature on bipolar disorder. Results: The 43 group attenders had a statistically significant higher mean score on the illness and lithium knowledge and the attitude to illness sections of the questionnaire than the 30 patients who did nto attend groups (P<0.001). A multiple regression analysis indicated that, in addition to group attendances, only reading literature contributed significantly to illness knowledge and attitude. Age, sex, duration of illness and socio-economic status did not contribute significantly to these outcome variables. Conclusions: Bipolar disorder patients who attended support group meetings and availed of relevant literature knew more about their illness and lithium therapy and expressed more positive and realistic views about their illness than those who only read literature and attended lectures.
Maternal views of the management of foetal remains following early miscarriage
Authors: Jackman Catherine , McGee Hannah , Turner Michael 
Published: March 2016

AbstractObjective:Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women.Method:Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements.Results:Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted.Conclusions:Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.