bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical use of structural magnetic resonance imaging in the diagnosis of dementia in adults with Down's syndrome
Authors: Strydom Andre , Hassiotis Angela , Walker Zuzana 
Published: March 2016

AbstractObjectives:Magnetic Resonance Imaging (MRI) has been used to assist the diagnosis of Alzheimer's Disease (AD) in adults with Down's syndrome (DS). However, the interpretation of the scans is difficult and clinical usefulness is uncertain. We aimed to summarise the current knowledge of MRI studies in adults with Down's syndrome with and without dementia and to discuss its implications for clinical practice.Method:We identified MRI studies in DS by a computerised literature search with Medline, Embase, and Psychlit from 1986 to 2001. We examined the references of identified articles and hand searched relevant journals. Structural MRI studies were selected as this type of imaging is most frequently used in clinical practice.Results:We included eight volumetric studies in adults with DS. Four of these included adults with DS and dementia. Overall, the size of brain structures such as cerebellum, hippocampus and cortex of adults with DS without dementia was significantly smaller than in normal controls. The basal ganglia were similar in size, and ventricles were enlarged. Furthermore, the size of brain structures in adults with DS and dementia was significantly different than in DS without dementia. In particular, ventricular and hippocampal volumes were affected.Conclusions:The change in brain structure associated with dementia can be detected on MRI of adults with DS. However, these may be difficult to interpret given the extent to which brain appearance in DS differs from that in the general population. Implications for clinical practice and future research directions are discussed.
Mental health legislation in child and adolescent psychiatry in England and Wales
Authors: McNamara David 
Published: March 2016

As colleagues in Ireland and England and Wales are bracing themselves for revisions of their respective mental health legislations, I would like to share some of the joys and tribulations of working within the legal framework of mental health of young people in England and Wales as it stands. (This is the first major reform of UK Mental Health legislation since the 1983 Mental Health Act, which was based on a full review of mental health legislation from the 1950s.)On first approach, the complexities of this framework can be daunting. However the underlying principles are similar to Ireland's. Ideally, health professionals, parents and children are working together in a co-operative therapeutic alliance. In reality, factors such as time, communication, resources, differences in professional judgements regarding thresholds for concern and action, interagency and interprofessional rivalries impact greatly on our day-to-day practice.
Adult ADHD: a controversial diagnosis?
Authors: Kirley Aiveen , Fitzgerald Michael 
Published: March 2016

AbstractAttention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity and impulsivity with onset in children before the age of seven years. ADHD is the most common disorder presenting to child guidance clinics and has been shown to be a well-validated diagnosis. Current estimates of prevalence range from 1%5%. The concept of adult ADHD as a clinical entity is an emerging but controversial area in psychiatry. While childhood ADHD is accepted as a reliable and valid diagnosis, the validity of adult ADHD as a disorder is unclear. This paper reviews the likely presenting features of adult ADHD and common comorbid disorders. Guidelines for assessment and management are discussed and the evidence for validity of the diagnosis is critically examined.
A variant of nymphomania in association with obsessive-compulsive disorder
Authors: Mulligan Aisling , Webb Marcus , Gill Michael 
Published: March 2016

AbstractA case is described of female compulsive sexual behaviour in association with obsessive-compulsive disorder (OCD). This patient had non-paraphitic compulsive heterosexual multiple partner behaviour, which is a symptom complex previously termed nymphomania. There were also nonsexual obsessions, compulsions and avoidance behaviours diagnostic of obsessive-compulsive disorder. The case is presented for its clinical interest, because ‘nymphomania’ is rare, and because the patient presented with symptoms subtly different to others in the literature. The patient consented to her case being reported in the medical literature.
Dealing with violent and aggressive patients: at what cost to nurses?
Authors: Crabbe Jillian , Alexander David A , Klein Susan , Walker Shona , Sinclair John 
Published: March 2016

AbstractObjectives: To determine the attitudes and experiences of nursing staff in relation to violent and aggressive patients.Method: A self-administered questionnaire booklet was distributed to 289 nursing staff working in ‘high-risk’ units within two NHS Trusts. In addition to assessing the frequency of violent incidents, the degree of burnout and post-traumatic symptoms experienced were assessed by the inclusion of two standardised measures in the survey, viz, the Maslach Burnout Inventory and the Impact of Event Scale-Revised respectively.Results: One hundred and fifty six (54%) nurses responded to this survey. Over two-thirds of nurses (72%) had been physically assaulted during the previous two years. The longterm psychological impact of these incidents was not related to whether or not a physical injury was sustained. A positive correlation between burnout and exposure to verbal abuse, threatened assault and violence was demonstrated.Conclusions: Nurses in these Trusts are exposed to an unacceptable level of violence or aggression from patients, potential implications of which include post-traumatic reactions and burnout. However, nurses are reluctant to report incidents of verbal abuse or threats formally, and they rely upon the support of their colleagues following ‘distressing’ incidents. To protect the wellbeing of their staff, hospital management needs to consider preventative measures, such as training and personal alarms, and improved reporting systems to ensure all incidents are accurately recorded.
Saints-protectors from headache – historical hints of suggestive therapy?
Authors: Skrobonja Ante , Golubovic Vesna , Golubovic Snjezana , Muzur Amir , Skrobonja Ante 
Published: March 2016

AbstractA short overview of several saints, venerated in Christian tradition as protectors from headache, is offered as an introduction to a more substantial debate on the possibility and value of analysing historical literary and iconographic sources and their interpretation. Headache of possible psychosomatic origin allows (auto) suggestive therapy obtained by the invocation of saints to have had considerable success. This possibility favours the opinion that historical material can be useful not only for cultural-anthropological, but also for modern medical considerations as well.
Eye movements and neurocognitive function in treatment resistant schizophrenia: a pilot study
Authors: Thampi Annette , Campbell Clarke , Clarke Mary , Barrett Suzanne , King David J 
Published: March 2016

AbstractObjectives: It is increasingly important to develop predictors of treatment response and outcome in schizophrenia. Neuropsychological impairments, particularly those reflecting frontal lobe function, appear to predict poor outcome. Eye movement abnormalities probably also reflect frontal lobe deficits. We wished to see if these two aspects of schizophrenia were correlated and whether they could distinguish a treatment resistant from a treatment responsive group.Methods: Ten treatment resistant schizophrenic patients were compared with ten treatment responsive patients on three eye movement paradigms (reflexive saccades, antisaccades and smooth pursuit), clinical psychopathology (BPRS, SANS and CGI) and a neuropsychological test battery designed to detect frontal lobe dysfunction. Ten aged-matched controls also carried out the eye movement tasks.Results: Both treatment responsive (p = 0.038) and treatment resistant (p = 0.007) patients differed significantly from controls on the antisaccade task. The treatment resistant group had a higher error rate than the treatment responsive group, but the difference was not statistically significant. Similar poor neuropsychological test performance was found in both groups.Conclusions: To demonstrate the biological differences characteristic of treatment resistance, larger sample sizes and wider differences in outcome between the two groups are necessary.
Deterioration in renal function following commencement of citalopram
Authors: Mayfield Neil , Anderson Kay , Rodger Colin 
Published: March 2016

AbstractWe report the case of an 85 year old woman, admitted to hospital with a two month history of a depressive illness. Within one week of commencing treatment with citalopram 20mg daily, she had developed a widespread rash, bilateral ankle oedema and a range of biochemical and haematological abnormalities, including marked elevations of plasma urea and creatinine and increased neutrophil and eosinophil counts. Following withdrawal of citalopram, her physical state returned to normal within two weeks. The episode is suggestive of acute interstitial nephritis triggered by citalopram, a phenomenon not previously reported in association with the selective serotonin reuptake inhibitors.
Costing the hospital-based process of resettling people with learning disability in the community
Authors: Hughes Damien M , McGinnity Maria , Kell John , Kennedy Oscar , Donnelly Michael 
Published: March 2016

AbstractObjectives: Much has been written about the costs and cost-effectiveness of community care for people with learning disabilities resettled from long stay hospital care. However, comparatively little has been published about the cost of hospital services relating to the preparatory process before eventual resettlement and the disengagement of formal, sustained input from hospital staff. This study describes and costs the input provided by a hospital based multi-disciplinary team into the resettlement of adults with learning disabilities from long stay wards in Muckamore Abbey Hospital in Northern Ireland between 1996 and 1999 (n = 71).Method: The study employs a retrospective survey design. Information about the nature and frequency of the input of each member of hospital multi-disciplinary team was collected for each former client. According to the level of professional resources expended during the resettlement process, each former client was then categorised into one of three categories. One case was then selected at random to represent each category. A summary of clinical information, a description of the resettlement process and an estimate of the cost of the process was provided for each case.Results: Approximately 55% of people resettled in the community during the study period did so with a modest degree of input from hospital staff. For 18% resettlement proved to be a demanding and prolonged process, requiring intensive input from hospital staff. Financial costs of the resettlement process ranged from approximately stg£1,500 to stg£8,000, with an average of stg£3,400 for each person.Conclusion: This study provides evidence of the input by hospital staff into the process of community resettlement of long stay hospital clients and the associated costs. These costs must be included in service budgets if quality care and appropriate service provision is to be maintained in resettlement practice.
Liaison psychiatry in rural general practice
Authors: Russell Vincent , McCauley MacDara , MacMahon John , Casey Sheila , McCullagh Heather , Begley Jillian 
Published: March 2016

AbstractThe recent government health strategy document described the integration between primary and secondary care in Ireland as often poor and outlined plans to redress this deficit. In mental health care, the gradual shift away from institutions over the past four decades has resulted in the GP becoming the most frequent professional contact for people with mental disorders. However, access to specialist opinion is usually available only for the fraction of psychiatric presentations which are formally referred to the psychiatric service.On-site psychiatric liaison to primary care is commonly practised in other countries but not in Ireland. Research in the area suggests possible advantages for approaches which aim to enhance GPs' psychiatric skills while selectively encouraging referral of more serious disorders. This model has been adopted by GPs and psychiatrists in east Cavan and may be relevant to other similar settings, especially in the context of forthcoming changes in the organisation of primary care services.
Psychiatric consultation to elderly medical inpatients in a general hospital
Authors: O'Neill Conor , O'Connell Henry , Lawlor Brian A 
Published: March 2016

AbstractObjectives: To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time.Method: One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously.Results: In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms.Conclusions: Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.
Computer-assisted learning in undergraduate psychiatry (CAL-PSYCH): evaluation of a pilot programme
Authors: Guerandel Allys , Malone Kevin , Felle Patrick 
Published: March 2016

AbstractObjectives: To introduce and evaluate a computer assisted learning programme in undergraduate psychiatry (CAL-PSYCH).Methods: An interactive e-learning environment was created within the University College Dublin portal to assist students in acquiring the necessary skills in undergraduate psychiatry. The pilot phase consisted of providing their lectures on-line on the interactive site. Data were gathered from the last group of students in 2001 (pre-CAL-PSYCH) and the first group of students using CAL-PSYCH in 2002. We included assessment of percentage of students accessing the site, attendance rates at face-to-face lectures and tutorials, and also a feedback questionnaire from students who accessed the site.Results: All responders had used CAL-PSYCH. Students gave higher ratings for quality and interactivity of lectures compared with the pre-CAL-PSYCH curriculum. Students also expressed enthusiasm about CAL-PSYCH and encouraged us to develop it further.Conclusions: Computer-assisted learning environments such as CAL-PSYCH provide the opportunity to bring modern e-learning techniques to medical education, and may provide a new model for life-long learning in medicine.
Combining psychiatric and psychological approaches in the inpatient assessment of aggression in a client with moderate intellectual disability
Authors: Grey Ian M , McClean Brian , Kulkarni Leena , Hillery John 
Published: March 2016

AbstractThe literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.
Postnatal depression: a study of the predictive effects of postnatal anxiety
Authors: Teissedre Frédérique , Chabol Henri 
Published: March 2016

AbstractObjectives: The aim of this study was to evaluate the predictive effects of anxiety, experienced on the third day after delivery, on postnatal depression, evaluated around the sixth week postpartum.Method: The subjects were 291 postpartum mothers who responded to a certain number of inclusion criteria. The EPDS (Edinburgh Postnatal Depression Scale) and the STAI (State-Trait Anxiety Inventory) were used to evaluate the anxious and depressive symptomatology on the third day postpartum and around the sixth week postpartum. The mothers who obtained scores indicating a probable risk of postnatal depression also completed the Beck Depression Inventory.Results: We observed that 31% of the mothers showed postpartum blues symptomatology on the third day postpartum. Around the sixth week postpartum 13% of the mothers showed postnatal depression. The results suggest that the level of trait anxiety (β = 0.39; t = 3.64 p < 0.05) and more particularly the intensity of the postpartum blues symptomatology (β = 0.50; t = 6.88 p < 0.001) can predict the risk of postpartum depression. Furthermore, 17.9% of the mothers with postnatal depression around the sixth week postpartum were not detected by the EPDS on the third day after delivery. However, all these mothers were detected by the State-Trait anxiety inventory.Conclusion: A high level of anxiety during the first few days after delivery may contribute to the mothers' risk of developing postnatal depression. The early detection of high anxiety levels may enable the early screening of mothers at risk of developing postnatal depression.
Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment
Authors: O'Neill Conor , Heffernan Patrick , Goggins Ray , Corcoran Ciaran , Linehan Sally , Duffy Dearbhla , O'Neill Helen , Smith Charles , Kennedy Harry G 
Published: March 2016

AbstractObjectives:To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.Method:All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.Results:There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.Conclusions:Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.
Persistence of psychological problems in adolescence: a one year follow-up study
Authors: James Deborah , Lawlor Maria , Sofroniou Nick 
Published: March 2016

AbstractObjectives:To examine the prevalence and persistence of psychological problems in older adolescents.Methods:This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.Results:Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.Conclusions:A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.