bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of clozapine in a mental handicap hospital — report of the first 17 patients
Authors: Boachie Ahmed , McGinnity Maria GA 
Published: March 2016

AbstractObjectives: To examine the process and outcome of use of clozapine in patients with mental handicap, with particular reference to selection of patients, response to treatment, adverse effects and withdrawal from treatment.Methods: The case notes and medication charts of all patients commenced on clozapine between January 1991 and December 1994 were examined.Results: Seventeen patients had been commenced on clozapine, the majority in the mild and moderate range of handicap. Fifteen had ICD-9 diagnosis of schizophrenia and all were refractory to conventional neuroleptics. Improvement was marked in 47% and substantial in 76%, with a mean daily dose of 453.8(sd = 238.5)mg and a range of 200mg-900mg. Reduction of aggressive behaviour was an important indicator of improvement. Five patients were withdrawn but only one related to side effects. Four patients had a past history of epilepsy and six others either developed seizures or EEG changes on treatment.Conclusion: Clozapine use has been associated with considerable benefit in patients with mild and moderate handicap wh o have schizophrenia. In this population aggression responded well but a high prevalence of drug-induced epilepsy was evident.
New long-stay patients — two years later
Authors: Gannon Miriam , Meagher David , Watters Liam 
Published: March 2016

AbstractObjectives: The aims of this study were to review the outcome of those long-stay patients two years after identification and to compare those discharged with those remaining in hospital in order to identify factors which might contribute to their continuing stay.Methods: All the new long-stay patients who were more than one year and less than six years on 1st March 1992 were included in the study. Their current placement. Legal status and demographic and clinical details were recorded. Findings: Sixtynine percent of the original cohort remained in hospital, 9% had died, and 22 % had been discharged, mainly to highly staffed accommodation. Approximately half of those remaining in hospital were considered suitable for community placement. Those remaining in hospital were older, had longer durations of illness and were more likely to be dangerous than those discharged.Conclusions: Despite continuing developments in community services a considerable number of new long-stay patients still remain in hospital and the proportion of those compulsorily detained remains unchanged.
The use of naltrexone, an opiate antagonist, in the treatment of opiate addiction
Authors: Farren Conor K 
Published: March 2016

AbstractObjective: The objective of this article is to review the use of the opiate antagonist naltrexone as an alternative to opiate agonist maintenance in the treatment of opiate addiction.Method: An extensive literature search, via Medline, Biosis, Psycinfo and other databases was carried out.Results: Naltrexone has been used in the treatment of opiate addicts in a variety of settings. A number of methods of induction onto naltrexone of recently abstinent addicts have been used in different settings. Naltrexone has had a wide range of outcome success with different populations and associated treatment regimes.Conclusions: The benefits of naltrexone can be compared with alternatives such as methadone maintenance and therapeutic communities. Naltrexone can be made more effective in the general population of opiate addicts with the use of adjunctive therapies.
Detection of personality disorders by a community mental health team: a study of diagnostic accuracy
Authors: Hassiotis Angela , Tyrer Peter , Cicchetti Domenic 
Published: March 2016

AbstractObjective: It is now widely recognised that personality disorders play a significant role in psychiatric practice. This study was set up to examine the diagnostic accuracy of the assessment of personality disorder in normal practice by a multidisciplinary community mental health team when compared with a formal assessment using a structured interview.Method: Forty-four patients originally assessed by team members of the Early Intervention Service (EIS), were re-examined using the Personality Assessment Schedule (PAS ICD-10 and original version) at a mean period of 16.3 months after first assessment. Specifically we tested the extent to which three personality disorder (PD) clusters (flamboyant, odd/eccentric, anxious/fearful) could be differentiated from either no PD at all or from the remaining PD clusters.Results: As expected, both flamboyant and odd/eccentric PD clusters were much more easily differentiated from no PD at all (overall accuracy of 87 % and 85 % respectively) than from other PD clusters (corresponding accuracy of 65 % and 50%) . In distinct contrast, the anxious/fearful cluster was much less accurately differentiated from no PD (accuracy of only 52%) than from other PD clusters (accuracy of 85%).Conclusion: The diagnosis of personality disorders in routine clinical practice is fraught with difficulties, especially when mental status symptoms closely resemble personality traits. The present results suggest that greater knowledge, training and experience can facilitate diagnostic accuracy.
Community and hospital residential care: a comparative evaluation
Authors: Carson Jerome , Cullen Deborah , Holloway Frank , Towey Aisling , Jumbo Angela , Smellie Norma , Glynn Tony 
Published: March 2016

AbstractObjective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.
Diogenes' syndrome — a load of old rubbish?
Authors: Drummond Lynne M , Turner Joanne , Reid Steven 
Published: March 2016

AbstractObjective: It has been suggested that presentation with self-neglect, domestic squalor and hoarding, represents a distinct syndrome, widely known as Diogenes' syndrome. The validity of this syndrome is controversial and we suggest that in previous series of such patients other psychiatric diagnoses, particularly obsessive compulsive disorder (OCD), may have been missed.Method: A series of 50 patients admitted for treatment of OCD were examined, looking for presentation with self-neglect, domestic squalor and hoarding. Response to treatment was also measured by comparing pre and post-treatment scores on the Beck Depression Inventory and Activity Checklist.Results: Of the sample 8% presented with all three features. This sub-group of patient had a poorer outcome than other patients with OCD.Conclusion: Presentation with self-neglect, domestic squalor and hoarding is not uncommon in patients with severe OCD and this supports the suggestion that patients previously described as having Diogenes' syndrome may have had undiagnosed OCD.
General practitioners' opinion of a new psychiatry of old age service
Authors: Kelleher Margaret 
Published: March 2016

AbstractObjective: To evaluate the reaction of local general practitioners to a new psychiatry of old age service 10 months following its inception.Method: An anonymous questionnaire was sent to all GPs in the catchment area of the Service. Questions asked the opinion of GPs on structure and process of the Service, and also asked for suggestions as to how the Service could patients did not have any reservations about being seen by a psychiatrist, but 72% of rural GPs felt the location of the service base (in the city) was a problem.Conclusion: The results of the study suggest that GPs are reasonably satisfied with the initial service offered by the new specialty. Future service developments must address issues highlighted such as access to the service for patients living outside the city, improving the inpatient facilities for patients with a functional mental illness, and improving communication with GPs.
Diogenes' syndrome: review and case history
Authors: O'Shea Brian , Falvey Jane 
Published: March 2016

AbstractOur objective in writing this paper was to present a case of Diogenes' syndrome and to examine the evolution of thinking about the phenomenon. To do this we looked at original case material and then carried out a literature review, the results of this showed the syndrome has been reported most often in the elderly and in higher socio-economic groups. It represents a non-specific final common pathway for many interacting variables.In our conclusion we found that a detailed multidisciplinary assessment is indicated in all cases. Further work is required to estimate the role of personality disorder and organic frontal lobe dysfunction in the aetiology of this syndrome. A multiaxial approach to diagnosis should be employed. Intervention should be based on objective findings and risk-assessment, rather than on ideological grounds. Irish law does not allow a large variety of options to the helping professions.
Using the Achenbach Child Behaviour Checklist in the differential diagnosis of disruptive behaviour disorders
Authors: Kelly Thomas P , McArdle Paul 
Published: March 2016

AbstractObjective: The report considers the utility of the Achenbach Child Behaviour Checklist in the differential diagnosis of the disruptive behaviour disorders.Method: Subscale scores on the parent completed Achenbach Child Behaviour Checklist were compared for three of 15 boys, the first diagnosed with attention deficit hyperactivity disorder, the second diagnosed with oppositional defiant disorder and a third non-clinical control.Result: The attention subscale of the Achenbach Child Behaviour Checklist was found to have a high level of sensitivity to children diagnosed with attention deficit hyperactivity disorder, but relatively poor specificity. The delinquent subscale was found to have limited sensitivity for oppositional defiant/conduct disorder group, but high levels of specificity. The aggressive subscale were found to have relatively high sensitivity for the oppositional defiant/conduct disorder group and relatively high specificity.Conclusion: The Achenbach Child Behaviour Checklist is useful in distinguishing between children with disruptive behaviour disorders and a non-clinical sample. The aggressive subscale appears to have potential clinical utility in the differential diagnosis of the disruptive behaviour disorders.
Folie a famille — the need for family perspectives in psychiatry
Authors: McCartney Mark , Leheup Rachel 
Published: March 2016

AbstractA case of folie a famille is described. The presenting symptom bearer was a child thus necessitating psychiatric contact with his family. This prevented the folie a famille from remaining covert as may have occurred had an adult presented in a similar manner. The possibility is raised that folie a plusieurs has a higher incidence than previously believed. Criticism is made of the tendency of adult psychiatry and its diagnostic systems to focus purely upon the individual. The investigation, formulation and management of the case using the family is outlined.
Isotretinoin therapy and depression – evidence for an association
Authors: Byrne Alan , Costello Morgan , Greene Elaine , Zibin Terry 
Published: March 2016

AbstractObjectives: The object of this paper is to evaluate the evidence suggesting an association between the use of the anti-acne agent isotretinoin and the subsequent development of depression.Method: Three case histories of individuals who had received treatment with isotretinoin and subsequently developed depression are reviewed.Results: All three individuals were noted to have a depressive illness which was notable by the prominence of symptoms of irritability, agitation and aggression.Conclusions: The indications from the three cases described suggest that there appears to be an association between depression and the recent use of isotretinoin. This may relate to the ability of isotretinoin to simulate hypovitaminosis A, with aggression, irritability and depression as a direct result of this effect. Young males may be particularly prone to developing this response.
Childhood sexual abuse histories in women with drug and alcohol misuse disorders
Authors: Horgan Ann , Cassidy CE , Corrigan Adrian 
Published: March 2016

AbstractObjectives:To audit the incidence of a history of childhood sexual abuse (CSA) in women with diagnoses of drug and alcohol misuse disorders.Method:A definition of CSA encompassing the US National Centre on Child Abuse and Neglect's definition of child sexual abuse was used. In the six month period of audit details of CSA were recorded from clinical data for all consecutive female new patients (n = 49) of the substance misuse service in St. Luke's Hospital, Armagh.Results:Of the 49 new patients, information on childhood sexual abuse was available for 44 subjects. Sixteen (36.36%) of 44 had a positive history of CSA.In 13 (81.25%) abuse occurred before the age of 16 years. Sexual intercourse was described by 50% and sexual contact by 50%. Only one patient had reported CSA to the police and only one patient had received counselling. There was a difference noted in the addiction profile of those with a history of CSA, 44% of this group had either alcohol dependence syndrome/harmful use of alcohol compared with 66% of the non-CSA group. The perpetrators were all male.Conclusions:Our audit confirmed other work which showed a high incidence of childhood sexual abuse histories in addicted women. This is one of the areas which may not be properly addressed by conventional addiction treatment programmes, which are male centred and male dominated. It adds to the growing body of evidence that suggests adaptations must be made as increasing numbers of women present for addiction problems.
An audit of violent incidents in a drug treatment centre
Authors: Fahy Sabina , Browne Roy , Sloan Darina , Keating Shay , O'Connor John 
Published: March 2016

AbstractObjectives: The aim of this study was to examine the prevalence of, and factors associated with violence in a drug treatment centre.Method: This study is a retrospective audit of all incident forms completed at an urban drug treatment centre between December 1991 and July 1996 with reference to case notes for additional clinical information on individuals involved in violent incidents.Participants included all patients attending the centre in the aforementioned time period who were involved in violent incidents. Information was obtained about the prevalence and severity of violent incidents and patient details including main drug of abuse, route of use, reason for attendance, comorbid axis 1 diagnosis, history of previous incidents and HIV status at the time of the incident.Results: One per cent of all patients were involved in violent incidents. Less than one quarter of incidents involved serious injury or assault. Most perpetrators were male intravenous heroin users on a methadone maintenance programme. Nurses and doctors were most frequently the victims of incidents. Ten per cent of patients had a history of previous incidents and almost half the perpetrators were HIV positive. A comorbid axis 1 diagnosis was found in 9% of perpetrators (n = 6), mainly alcohol dependence syndrome.
Outcome of treatment for Irish alcoholic women
Authors: Corrigan Eileen M , Butler Shane , Camasso Michael J 
Published: March 2016

AbstractObjective: To assess the outcome of treatment, a cross section of women from seven inpatient centres treating alcoholics were interviewed twice: as they entered treatment (n=114) and one year later (n=74) when they returned to the community.Method: The patients were interviewed as they began treatment and 65% were traced for interviews one year later. Measures of self esteem, emotional health and drinking patterns are presented over time.Results: Approximately one half of the women were abstinent when interviewed again and improved emotional health was related to abstinence. Of those who continued to drink many reduced their intake. A logistic regression analysis was applied to the data to explain the results. Among the major findings was the ability of therapists to predict subsequent drinking with a high degree of accuracy.Conclusions: All of the services have abstinence as their goal. This could be challenged since at follow up only half of the women are abstinent. Controlled drinking may well be a valid objective if abstinence fails or could well be a valid objective for some patients.
Training in psychodynamic psychotherapy: the psychiatric trainee's perspective
Authors: Trigwell Peter J , Curran Stephen , Milton John , Rowe Celli 
Published: March 2016

AbstractVarious problems can occur when embarking upon training in psychodynamic psychotherapy for the first time. If the difficulties experienced by trainees are not given serious attention by supervisors, trainees may give up at an early stage. This paper looks at the subjective difficulties experienced by three junior trainees in psychiatry in adjusting to such training, and includes comments in reply from one of the organisers of the course which the trainees attended. It is essential for supervisors to address trainees concerns openly, in order to avoid a further decline in the use of this important part of the “therapeutic armamentarium”.
Non-compliance and related phenomena
Authors: O'Shea Brian 
Published: March 2016

AbstractObjective:Review of literature on non-compliance with medication in psychiatric patients.Method:Computer and manual search of English language literature on non-compliance with drugs, psychiatric disorder, and phenomena which may be related, such as readmission and discharge against medical advice.Results:The literature is discussed and a tentative checklist of risk factors for non-compliance is offered, as is advice on ways in which the problem may be minimised. It is noted that there is an emphasis on major mental disorders in the published literature.Conclusion:There is no stereotypical defaulter. A high index of suspicion is essential. As far as possible, the patient should be educated to share in the responsibility for treatment, and concerned relatives and others can often play a pivotal role. More research is required on compliance problems in the minor psychiatric disorders. Close liaison with the general practitioner is vital.
Two cases of transvestophilia arising following behavioural psychotherapy treatment of obsessive compulsive disorder
Authors: Rani S , Drummond Lynne 
Published: March 2016

AbstractEarly psychodynamic formulations of obsessive compulsive disorder (OCD)suggest that its aetiology lies in repressed sexual impulses. Despite this, sexual aberration has rarely been reported in conjunction with OCD or arising following treatment. This paper describes two case histories of patients with severe, chronic OCD whose sexually deviant behaviour increased following successful behavioural psychotherapy. Classical Freudian, behavioural cognitive and neuropsychological models for this finding are discussed.
Suicide as a complication of schizophrenia
Authors: Kelleher Michael J , Hynes Fiona , Kelleher Michael JA , Keeley Helen 
Published: March 2016

AbstractThe social, personal, occupational and domestic deficits of schizophrenia are well known. Perhaps it has not been emphasised sufficiently that people suffering from schizophrenia also have an increased mortality. It is important to recognise that suicide is the commonest form of death among both male and female schizophrenics and occurs in 10%-15% of cases.
Dyads and triads of abuse, bereavement and separation: a survey in children attending a child and family centre
Authors: Sheerin Declan 
Published: March 2016

AbstractObjectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome.Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made.Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement.Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.