bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient-controlled benzodiazepine dose reduction in a community mental health service
Authors: Raju Bangaru , Meagher David 
Published: March 2016

AbstactObjectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.
Old age medical patients screening positive for depression
Authors: Winrow Adrian Mark , Holmes John David 
Published: March 2016

AbstractObjective: The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge.Method: Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated.Results: Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study.Conclusion: Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.
Psychiatric morbidity in a cross-sectional sample of male remanded prisoners?
Authors: Linehan Sally A , Duffy Dearbhla M , Wright Brenda , Curtin Katherine , Monks Stephen , Kennedy Harry G 
Published: March 2016

AbstractObjectives: To estimate the psychiatric service requirements for the remand population.Method: We interviewed 232 (42.6%) men, a representative sample of men on remand, using the SADS-L, SODQ and a structured demographic interview.Results: We found high rates of psychiatric morbidity in our sample. The six month prevalence of psychosis was 7.6%, almost twice the rate in a recent international meta-analysis. Major depressive disorder was present in 10.1% (six month prevalence). Substance misuse problems were also common but there was no significant difference between rates of substance misuse in psychotic and nonpsychotic prisoners. A total of 31.2% had a lifetime history of any mental illness (excluding substance misuse, adjustment disorder and personality disorder).Conclusions: The high levels of psychiatric morbidity detected in our sample indicate a substantial unmet need for mental health services and addiction treatment services for the mentally ill in Irish prisons.
Delirium in the hospitalised elderly: An audit of NCHD prescribing practice
Authors: Hally Odile , Cooney Colm 
Published: March 2016

AbstractObjectives: This study was carried out to determine the prescribing of psychotropic medication of non-consultant hospital doctors in the management of delirium and to compare this with best practice guidelines.Method: A structured questionnaire was forwarded to all non-consultant hospital doctors (n = 95) working at St Vincent's University Hospital and data was collected over a six month period. The questionnaire addressed type, dose and route of psychotropic medication use in delirium as well as adjunctive measures used to manage delirium.Results: There was a 55% response rate (n = 52). Haloperidol and lorazepam were the two most frequently prescribed psychotropic agents used and over one third of respondents (n = 20) reported the use of risperidone. There was wide variation in doses used and a substantial proportion of NCHDs used higher than recommended starting doses for elderly patients with delirium. In addition, the intramuscular route was reported as the commonest route of administration with a majority of respondents reporting infrequent intravenous route of administration.Conclusions: The drug choice reported by respondents followed best practice guidelines. However, the wide variation in drug doses used and frequency of parenteral route of administration (particularly intramuscular) indicate the need for increasing awareness of best practice international guidelines. Guidance and clarification regarding the use of atypical antipsychotic medication is required following concerns about their use in dementia.
Music therapy in the treatment and management of mental disorders
Authors: Edwards Jane 
Published: March 2016

AbstractObjectives: An increasing number of research studies support the benefits of providing music therapy in addition to standard treatment for people who have mental disorders. The objective of this paper was to review and summarise recent research findings in relation to this work.Method: A review of music therapy studies published since 1994 was undertaken. Criteria for including papers were that they a) were published in English in an indexed, peer-reviewed journal, and b) were conducted as a randomised controlled trial (RCT) or a controlled trial (CT), or c) provided a meta-analysis of existing studies. The large number of papers pertaining to music therapy for older adults who have mental disorders, including Alzheimer's disease and other types of dementia was not included.Results: The findings support a role for music therapy as a structured interaction that patients are able to use to participate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music therapy is demonstrated to be a beneficial intervention for people who have enduring mental illness. Music therapy invites and encourages participation from people of lower functioning levels and employs a non-verbal medium with which people have prior positive associations and in most cases have lifelong experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.Conclusions: Music therapy is beneficial for patients receiving care for mental disorders and establishing this therapy within mental health service provision should be considered.
An Irish case of pulmonary emboli secondary to clozapine therapy
Authors: O'Luanaigh Conor , Scully Paul 
Published: March 2016

AbstractBackground:Clozapine is the prototype atypical antipsychotic used for treatment-resistant schizophrenia, but its use has been limited by the well-established association with agranulocytosis. An increased risk of other serious adverse events such as myocarditis and thromboembolism has also been suggested to be associated with clozapine therapy.Aims:We describe an Irish case of multiple pulmonary emboli detected by CT pulmonary angiogram thought to be secondary to clozapine therapy.Conclusion:Although clozapine is a very efficacious antipsychotic its many side-effects limit its use. Pulmonary embolism must be remembered as a potential rare side-effect in clozapine therapy. Underlying mechanisms are still unclear although several have been proposed.
Violence and aggression in the Drug Treatment Centre Board
Authors: Whitty Peter , O'Connor John J 
Published: March 2016

AbstractObjectives: We sought to determine the prevalence of and the factors associated with violent and aggressive incidents among clients attending an out-patient methadone stabilisation and detoxification programme in Dublin.Methods: We retrospectively examined all incident report forms over a two-year period. We also obtained information on demographics, main drug of abuse, timing and location of the incident as well as psychiatric and physical comorbidity among the perpetrators from case note review.Results: Two hundred and ninety-five incidents occurred over the study period. The overall rate of violence and aggression was 85 per 1,000 clients attending the centre per year. Most incidents involved verbal abuse. Females were significantly more likely to be involved in assaults compared to males. A high proportion of clients (80%) who were physically aggressive tested positive for benzodiazepine medication.Conclusions: Levels of recorded violence have remained stable however racial abuse has increased in recent years. The relatively low overall rate of violence suggests that existing measures have helped reduce the number of aggressive and violent incidents in the centre. Most of the victims were either doctors, nursing staff or general assistants. This finding reflected their respective roles in the centre, which included limit setting and dealing with positive drug screens among clients.
Detection, assessment and management of eating disorders; how involved are GPs?
Authors: Flahavan Claire 
Published: March 2016

AbstractObjectives: To determine the extent to which general practitioners are currently active in the screening, assessment, diagnosis and management of eating disorders. To identify current deficits in service delivery for eating disordered patients, as identified by general practitioners.Method: A postal questionnaire was circulated to 360 general practitioners within the greater Dublin area and North Eastern Health Service Executive.Results: Response rate was 25%. Respondents had lower case-loads of eating disordered patients than would be expected given the epidemiology of anorexia and bulimia nervosa. Most do not routinely screen for eating disorders, even in at-risk populations and are unaware of the current evidence-based data for guidance. GPs do not feel confident at managing eating disorders within the primary care setting and see their chief role as that of referral to psychiatric services. Treatment outcomes are typically poor. Concern was expressed at the lack of access to specialist treatment in the public sector. Specific deficits in service provision were highlighted including delays in assessment, lack of services appropriate to the adolescent population, poor service transition, and poor availability of psychotherapy at primary care level.Conclusions: Eating disorders are currently underdiagnosed in the primary care setting. Use of simple screening tools might aid detection of pathological eating patterns, particularly in at-risk groups. General practitioners feel under-equipped to manage these complex disorders, given that the resources required to provide high quality care are not widely available. Better integration of primary and secondary services, coupled with training for GPs in the area of screening, assessment and diagnosis, may lead to earlier intervention and improved outcomes.
Tackling a long waiting list in a child and adolescent mental health service
Authors: Lynch Gordon , Hedderman Elma 
Published: March 2016

AbstractObjective: Long waiting lists have a negative impact on client satisfaction, staff moral and referrer's opinion of the service. The aim of this project was to decrease a waiting list from a maximum wait of more than one year to a wait of no more than six weeks.Method: We introduced three simultaneous initiatives to decrease a long waiting list; (i) an individually led triage system (ii) setting-up an attention deficit hyperactivity disorder (ADHD) specialist team and (iii) division of the residual waiting list between team members. These initiatives were introduced and analysed over a ten month period. The study period ran from 1/3/2004 to 31/12/2004.Results: The waiting time to first appointment was significantly reduced. At the beginning of the study there were 62 people waiting to be seen and each had waited an average of 122 days with a waiting time range of 0-449 days. At the end of the study, there were 19 people waiting with a mean waiting time of 19 days and a range of 0-168 days.Conclusions: The single most powerful intervention was the triage system. The ADHD clinic allowed referrals to be streamlined in a very structured and efficient way. The division of the residual waiting list was not as onerous as it first appeared. The service saw more referrals then ever during the study period. Referrers and families appreciated being seen more quickly. By removing the burden of the waiting list from staff the potential for creative thinking around further development of the service increased.
Olanzapine-induced rhabdomyolysis
Authors: Sood Loopinder , Owen Andy , Saini Mandeep 
Published: March 2016

AbstractWe present a case of possible olanzapine-induced rhabdomyolysis in the absence of other features of neuroleptic malignant syndrome (NMS). There is evidence to suggest that there are different underlying pathophysiological mechanisms for rhabdomyolysis occurring alone, in contrast to when it presents as part of NMS. This has possible implications for drug rechallenge which is discussed.
Duloxetine-mirtazapine combination in depressive illness: The case for Limerick ‘rocket fuel’
Authors: Meagher David , Hannan Noel , Leonard Maeve 
Published: March 2016

AbstractThe use of complex psychopharmacological regimens is increasingly advocated in more difficult to treat depressive illness. The combination of venlafaxine with mirtazapine – ‘California rocket fuel’ is one such example involving an SNRI combined with a NaSSA. We describe two cases that highlight the potential usefulness of duloxetine used in combination with mirtazapine that also emphasise the danger of drug-induced hypomanic switching. This combination may have a specific role for carefully selected patients but caution is needed given the potential to induce profound alterations in mental state.
Drug diversion of Oxycontin in chronic pain syndrome
Authors: O'Domhnaill Sean , O'Keeffe Declan , Malone Kevin 
Published: March 2016

AbstrsctA case is described in which a man with chronic pain syndrome (CPS) presented to a city General hospital in suicidal crisis after referral from a provincial psychiatric unit, having taken an overdose of a variety of medications, precipitated by the absence of his opioid (Oxycontin) analgesia which he had been abusing intra-nasally. This is to our knowledge the first reported case in Europe of drug diversion from oral to intranasal use of Oxycontin, a controlled-release preparation of the synthetic opiate, oxycodone hydrochloride. There is also a dearth of reference to the abuse potential of this agent in the European literature. As sufferers from chronic pain syndrome increase in number, and opiate prescription rates worldwide are maintained, this case highlights the potential of opiate abuse or dependence and drug diversion emerging as a significant medical problem in CPS patients in Europe.
Anorexia nervosa or otherwise? The usefulness of adult diagnostic systems in child and adolescent eating disorders
Authors: Lydon Alma , Agbahovbe Onome , Doody Brendan 
Published: March 2016

AbstractWe report on the case of a 15-year-old boy referred to Warrenstown inpatient unit for management of what appeared to be a typical case of anorexia nervosa. Over the course of his admission however, this diagnosis was no longer considered appropriate and substituted for a food avoidance emotional disorder. This is one of a number of cases of young males who have recently been referred for inpatient management of anorexia nervosa but which emerged into something quite atypical. The limited usefulness of the ICD-10/DSM-IV criteria in the diagnosis of an eating disorder in childhood and adolescence in this case reflects a broader level of discontent with the application of such diagnostic classification systems in a paediatric population.
Alcohol dependence and mood state in a population receiving methadone maintenance treatment
Authors: MacManus Edward , Fitzpatrick Clare 
Published: March 2016

AbstractObjectives: The aim of this study was to assess the prevalence of alcohol dependence and anxiety and depressive disorder symptomatology among heroin users in drug treatment.Method: Fifty-five clients on methadone maintenance treatment programmes in Dublin were interviewed.Results: Prevalence rates were found to be 56% [n = 31] for alcohol dependence, 56% [n = 31] for anxiety disorder symptomatology, and 42% [n = 23] for depressive disorder symptomatology. This finding of comorbid alcohol dependence and psychopathology among methadone maintenance treatment clients suggests that both clients' health and methadone maintenance treatment participation and completion rates may be compromised.Conclusions: Alcohol dependence and psychopathology among methadone maintenance treatment clients should be considered when providing effectively targeted services to the drug using population.
The challenge of applying mental health law reform to the intellectual disability sector in Ireland
Authors: Leonard Peter , Hillery John , Staines Mary 
Published: March 2016

The full implementation of the Irish Mental Health Act 2001 brings about the introduction of an altered legal definition of mental disorder, mandatory review of involuntary detention within a 21-day period and new statutory rules regarding the use of seclusion and mechanical means of bodily restraint. This legislation came into full effect on November 1, 2006. The implications of this for the intellectual disability psychiatry sector are profound and the full ramifications of these changes will only become fully apparent over time.This also occurs at a time when we are facing unprecedented developments in government mental health policy, major changes to postgraduate training in psychiatry, difficulty recruiting appropriately skilled staff and increasing legal requirements on employers to ensure staff safety. Several of these drivers for change may appear at face value to be in conflict and a complex balance will be required if these changes are to be blended to ultimately improve the care provided to clients of our services.
Suicide and the reluctance of young men to use mental health services
Authors: Burke Shane , McKeon Patrick 
Published: March 2016

AbstractYoung men are grossly over represented in Irish suicide statistics, yet this group is the least likely to use mental health services. This paper outlines why young men are reluctant to access mental health services, framing the problem in the context of risk factors for suicide such as binge drinking and social change. The paper argues that de-stigmatising mental illness and encouraging young men to seek help for emotional problems should be a priority for policymakers.
Integrating mental health and primary care services: a challenge for psychiatric training in Ireland
Authors: Wright Brenda , Russell Vincent 
Published: March 2016

AbstractA Vision for Change, the report of the Expert Group on Mental Health Policy asserts as one of its key recommendations the enhancement and formalisation of links between specialist mental health services and primary care. As part of a higher training post in psychiatry a consultation-liaison service was provided by a senior registrar in three rural general practices. This paper describes the experience of this initiative from an educational perspective and discusses the broader implications for Irish psychiatric training. With an emerging emphasis on collaborative mental health care there needs to be an appreciation of the specific set of skills that psychiatry trainees must learn in order to be effective in primary care settings. The tandem development of the appropriate services and training in an Irish context will require dedicated funding and resources.
A needs analysis for the provision of a speech and language therapy service to adults with mental health disorders
Authors: Walsh Irene , Regan Julie , Sowman Rebecca , Parsons Brian , McKay A. Paula 
Published: March 2016

AbstractObjectives: To examine a sample of adults with mental health disorders attending at an area psychiatric service, for the presence of impairments in language, communication and swallowing, using a test battery administered by speech and language therapists.Method: The study surveyed a randomly selected sample (n = 60) of patients from an acute psychiatric inpatient unit and associated community services, using several standardised measures of language, communication and swallowing.Results: On this test battery, over 80% (50/60) of subjects studied demonstrated impairment in language; while over 60% (37/60) presented with impairment in communication and discourse. Over 30% (18/58) of subjects assessed showed some impairment in swallowing.Conclusion: Use of this test battery confirmed the presence of language, communication and swallowing impairments in many patients in this sample of attenders at a general psychiatry service. We suggest that this study provides evidence for a (currently unmet) need for specialist speech and language therapy assessment and support among this patient population.
Routine investigations in paediatric psychopharmacology
Authors: Mulligan Aisling , McNicholas Fiona , Moran Tom 
Published: March 2016

AbstractObjectives:This study examines (1) what are the minimum accepted baseline investigations recommended in the literature prior to prescribing in child psychiatry and (2) whether these investigations are routinely performed.Method:Medical literature on prescribing in child and adolescent psychiatry was reviewed, and a list of minimum baseline investigations recommended in the literature was established. A postal survey was performed to establish what current clinical practice is among child and adolescent psychiatrists. Current practice was compared with the recommendations in the literature.Results:There are nine minimum accepted baseline investigations which are consistently recommended in the literature on child psychiatry. Six investigations are routinely performed by over 75% of respondents. However only 30% (n = 16) reported that they ‘always’ carried out eight or more of the nine recommended minimum investigations.Conclusions:A consensus statement is necessary, providing a list of recommended investigations prior to prescribing in child and adolescent psychiatry. Continuing medical education can then highlight the importance of these investigations.