bluuebunny/crossref_metadata_2025_split huggingface dataset:
International human rights law and mental illness
Authors: Tobin John 
Published: March 2016

AbstractThe Irish State has been party to a collection of international treaties and declarations that directly affect the care of those who suffer from mental disorders. These documents set up what are considered as minimum core standards that outline the standard of care that should be provided as a basic human right. This article reviews the relevant sections of these documents and reflects as to how they have been applied in Ireland. International conventions, which have the status of a treaty, are monitored and interpreted by various commissions and committees. This article draws on the comments of these bodies as to how a state should provide for those with mental illness. Areas such as the rights of children who are mentally ill and those who are detained by the state are examined in detail. Other areas covered are the right to the highest attainable level of mental health care, the right not to be subjected to a clinical trial, equal access to mental health care, and the right to be safeguarded against unjust involuntary detention.
The homeless mentally ill – an audit from an inner city hospital
Authors: O'Neill Aoife , Casey Patricia , Minton Rose 
Published: March 2016

AbstractObjective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group.Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist.Results: A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group.Conclusions: Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.
Disulfiram induced peripheral neuropathy: between the devil and the deep blue sea
Authors: Behan Caragh , Lane Abbie , Clarke Mary 
Published: March 2016

AbstractDisulfiram is widely used for the aversive treatment of alcoholism. It is well tolerated in most patients; however 1:15,000 will develop peripheral neuropathy, which is frequently misdiagnosed as alcoholic neuropathy. Most cases present with a motor-sensory neuropathy of the lower limbs, which tends to improve when administration ceases, though some cases may be left with permanent sequelae. This adverse reaction can be avoided by using the lowest effective dose. A literature review using the Medline revealed 66 citations relating disulfiram to peripheral neuropathy, and the number of cases reported is small.
Toxic psychosis? Duration of untreated psychosis, symptomatology and cognitive deterioration in first episode psychosis
Authors: Lawoyin Richard , Gaynor Keith , Dooley Barbara , Lawlor Elizabeth , Clarke Mary , O'Callaghan Eadbhard 
Published: March 2016

AbstractObjectives: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample.Method: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology.Results: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors.Conclusions: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.
Admissions to a national forensic hospital 1997-2003
Authors: Wright Brenda , O'Neill Conor , Kennedy Harry G 
Published: March 2016

AbstractObjectives: We set out to review all admissions from the criminal justice system to the Central Mental Hospital from January 1997 to December 2003, with particular attention to patient diagnoses, offences, source of admission, length of stay, and patterns of discharge. This study was undertaken to assist with future service planning and determination of resource needs.Methods: The service maintains a combination of electronic and handwritten records of all admissions. Information was extracted concerning all admissions from January 1, 1997 to December 30, 2003. The data was analysed using a statistical package, SPSS 11.0 for Windows.Results: Nine hundred and eighty-six admissions of 780 individuals from the criminal justice system were recorded from January 1997 to December 2003. There has been an increase in the proportion of patients admitted suffering with severe mental illness. There has also been a significant shift in the pattern of discharges, with a higher proportion of patients leaving to return to their local hospital. The proportion of admissions returned to prison has fallen from 91.1 % in 1999 to 64.7% in 2003, while 3.3% of individuals admitted became new long-stay cases.Conclusions: A shift in the profile of patients admitted in recent years reflects changes within the National Forensic Mental Health Service. An increased provision of regular and structured psychiatric input to the prisons has facilitated the identification of prisoners with mental illness. The shift from prison liaison to diversion from the Criminal Justice System to mental health services is however in its early stages.
Analysis of referral letters to a department of old age psychiatry
Authors: Campbell Fiona , Parsons Brian , Loane Ruth 
Published: March 2016

AbstractObjective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.
Facilitating journey to recovery
Authors: Khan Hammad , Murray Emmet 
Published: March 2016

AbstractThe Irish ‘Vision for Change’, 2006 mental health policy document proposes a framework for promoting mental health and a recovery approach to inform every level of service provision. Comprehensive assessment by the rehabilitation and recovery multidisciplinary team with active involvement of the service user is crucial in the identification of needs, goals and recovery factors. This paper outlines importance of a comprehensive assessment tool, which helps to guide the service user towards identification and achievement of their goals while encompassing the recovery ethos.
Dr Ada English: patriot and psychiatrist in early 20th century Ireland
Authors: Davoren Mary , Breen Eugene G , Kelly Brendan D 
Published: March 2016

AbstractDr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.
Deliberate self-harm in children and adolescents: an 11-year case note study
Authors: McNicholas Fiona , Fagan John , Tobin Brid , Doherty Mairin , Adamson Neil 
Published: March 2016

AbstractObjective:To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour.Method:All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning.Results:During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%.Conclusion:Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.
Antidepressant augmentation and combination in unipolar depression: strong guidance, weak foundations
Authors: Kolshus Erik , Douglas Leonard , Dunne Ross 
Published: March 2016

Depression will be the second leading contributor to the global burden of disease by 2020. In Ireland, in 2009, 6061 people were hospitalised with depressive disorders. This represents a significant economic and social burden. There is growing awareness of the difficulty in treating depression with medications alone. The likelihood that a patient will achieve remission with the first antidepressant tried is around 30%, and the rates are similar for the second antidepressant tried. This falls to around 15% after three trials. Many patients are exposed to pharmacotherapy for extended periods of time with little beneficial effect, but often with side-effects. Patients are therefore in great need of clear information with regard to their chance of success. Clinicians are in need of clear guidance on prescribing strategies which have proven efficacy. However, this guidance often discusses treatment strategies based on varying levels of evidence. Guiding bodies may approach the problem from varying perspectives. The UK National Institute for Health and Clinical Excellence (NICE) has a clear government mandate with regard to provision of not only effective but cost-effective treatments. The British Association of Psychopharmacology (BAP) is an independent body of interested researchers and therefore may discuss prescribing options from the point of view of tertiary care institutions, and university centres. The South London and Maudsley NHS Foundation Trust publish the popular Maudsley guidelines. These are perhaps more pragmatic in nature, but include very low levels of evidence, including case series.The American Psychiatric Association (APA) is an independent member association which also publishes guidelines. These are published in the American Journal of Psychiatry and the latest guidelines were published in October 2010.All these bodies attempt to weigh their advice according to the level of evidence available and aim to provide clinical guidance in difficult situations. The burden on guiding organisations is to provide some direction and clarity in areas that are often unclear or controversial. Clinical guidelines are one method of providing support and guidance to busy clinicians. However, this clinician-centered approach has limitations. The onus is on the authors of the guidance to provide ever-more treatment options. This may mean that conclusions about the efficacy of medications is overstated or the limitations of the literature not fully explored in explanatory notes.
Whack induced psychosis: A case series
Authors: El-Higaya Emam , Ahmed Mohamed , Hallahan Brian 
Published: March 2016

Abstract‘Whack’ is a new psychoactive substance available until recently in ‘head shops’. It contains two active constituents, 4-fluorotropacocaine and desoxypipradrol. We present two case reports of subjects who developed acute psychotic states after using Whack. Both individuals displayed similar affective and anxiety symptoms in the presence of significant psychotic symptoms. Both required inpatient treatment but displayed a good treatment response to atypical antipsychotic agents. To our knowledge, this is the first published case series relating to this psychoactive substance.
Exhaustion, depression and hopelessness in cardiac patients: a unidimensional hierarchy of symptoms revealed by Mokken scaling
Authors: Doyle Frank , Kowalczyk Aleksandra , McGee Hannah , Conroy Ronán M 
Published: March 2016

AbstractObjectives: Depression and vital exhaustion are associated with poor cardiovascular prognosis, but there is substantial overlap between these constructs. Factor analytic studies have been inconclusive, and may not be the optimal analytic strategy to assess dimensionality. We assessed whether exhaustion and depression formed a single, hierarchical dimension using a form of nonparametric item response theory.Methods: Patients with acute coronary syndrome (n = 430) completed questionnaires assessing depression and vital exhaustion. Mokken scaling was used to assess dimensionality.Results: Mokken scaling formed a strong unidimensional scale, ordered in a hierarchy reflecting prevalence: fatigue (common), depression (less common) and hopelessness (rare).Conclusions: Depressive symptoms form a clear hierarchy in cardiac patients, from fatigue to hopelessness. Vital exhaustion may be considered a less severe form of depression. Use of hierarchical scales may allow clinicians to better determine clinical significance and target interventions.
ECT: An investigation of lay attitudes and experiences in an Irish sample
Authors: Besani Chiara , Hevey David , Mangaoang Maeve , Lucey James V 
Published: March 2016

AbstractObjectives: Electroconvulsive therapy (ECT) is one of the most controversial psychiatric treatments of the modern era. Few studies have used validated scales to examine attitudes and knowledge regarding ECT in lay people. We examined attitudes, knowledge and experience of ECT using standardised questionnaires in Irish lay people, and compared the present results with the findings from a similar study reported over 25 years previously.Methods: A total of 103 lay people were recruited from a variety of settings and completed a questionnaire. Data were analysed using independent samples t-tests, χ2 tests and Pearson correlations.Results: Attitudes to ECT among Irish lay people are negative and knowledge of the treatment is poor. A significant correlation (r = 0.32) was found between knowledge and attitudes, with higher levels of knowledge associated with more positive attitudes. People with relatives who experienced ECT had a significantly higher ECT knowledge than the people without such relatives (p < 0.05).Conclusion: Results confirmed previous findings and revealed novel statistically significant factors that contributed to attitudes towards ECT. Further replications are required to examine the findings' robustness and the relationship between attitudes, knowledge and experience. Such research can help increase the understanding of ECT and remove the stigmatisation associated with ECT. Mental health education programmes should consider the relation between knowledge and attitudes to better inform programme focus and content.
Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective
Authors: Ahmed Mohamed , Dineen Brendan , O'Brien Sinead , Carney Philip A 
Published: March 2016

AbstractObjectives: This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.Method: Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.Results: One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.Conclusions: There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.
Lithium and prevention of cognitive impairment
Authors: Abidin Zareena , Cooney Colm , Jackson Deirdre , Freyne Aideen 
Published: March 2016

AbstractObjective:To examine the rate of cognitive decline and occurrence of dementia among patients attending a lithium clinic for those aged 65 years and over.Method:Retrospective chart review of the cognitive function of 29 patients receiving maintenance lithium treatment attending the Dublin South East Old Age Psychiatry service, over a nine-year time period.Results:Twenty-nine patients were included in the study (20 female, nine males), with a mean age of 79 years. Two patients had concurrent dementia. Six patients fulfilled ICD10 criteria for mild cognitive disorder and all of these patients also fulfilled revised consensus criteria for mild cognitive impairment amnestic subtype. Sixteen patients were commenced on lithium as an augmentation treatment for recurrent depressive disorder, 12 patients were on treatment for bipolar affective disorder and one patient on treatment for schizoaffective disorder. Patients had been receiving lithium treatment for an average of 109 months with follow-up by the service for a mean duration of 38 months. The initial mean MMSE score of patients at first presentation to the service was 26.9 (SD = 5.6) compared to a mean MMSE score 25.8 (SD = 5.8) (CI of change in MMSE score at 95% level = −2.1 and 0) at follow-up. The mean MMSE of patients with mild cognitive impairment prior at first contact with the service was 26.8 (SD = 3.2) and at follow-up was 26 (SD = 3.2) which was not statistically significantly different (p=0.40) (CI for change in MMSE at 95% level = −3.2 to 1.5). No patient had developed incident dementia during the follow-up period of the study.Conclusion:The results tentatively suggest that lithium may have a protective effect against cognitive decline and a neuroprotective role in patients with concurrent affective disorder and cognitive impairment. Multi-centre prospective studies of cognitive function in patients attending lithium clinics are needed to examine the neuroprotective properties of lithium.