bluuebunny/crossref_metadata_2025_split huggingface dataset:
An economic evaluation of inpatient treatment versus day hospital care for psychiatric patients
Authors: O'Shea Eamon , Hughes Jenny , Fitzpatrick Lourde , Dunne Elizabeth , O'Sullivan Mary , Cole Margaret 
Published: March 2016

AbstractObjectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 -February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.
Criminal responsibility and mental illness in Ireland 1850-1995: fitness to plead
Authors: Gibbons Pat , Mulryan Niamh , McAleer Angela , O'Connor Art 
Published: March 2016

AbstractObjectives: To describe forensic and clinical characteristics of unfit to plead defendants in Ireland between 1850 and 1995 as well as outcome in terms of length of stay in custody and ultimate disposal of cases. These data are compared with studies from the US and the UK. The White Paper on Mental Health (1995) highlights the need for significant change in the management of mentally ill defendants who come before the courts. The current criteria for the assessment of fitness to plead date from 1836. There has been little previous research on the use of fitness to plead procedures in Ireland which might guide future law reform.Method: This is a retrospective study of demographic, forensic and clinical data on an almost complete sample of 488 unfit to plead patients admitted to the Central Mental Hospital between 1850 and 1995. A standardised profile was completed on each subject with data drawn from hospital records and entered onto a database for analysis.Results: The use of the fitness to plead procedures peaked in the period 1910-20, and has fallen into substantial decline since then. Defendants were usually male, with a mean age of 37 years who had been charged with a violent crime. Three quarters of defendants were psychotic on admission. The mean length of detention was 14.3 years and only 4% were ultimately returned for trial.Conclusions: The decline in the number of fitness to plead findings is probably related to the reluctance of defendants to use the procedure due to the resulting prolonged period of detention. The introduction of a formal judicial review procedure to reassess the appropriateness of detention is urgently required to protect the civil liberties of those found to be unfit to plead.
Patterns of service use among people with learning disabilities discharged from long-stay hospital care in Northern Ireland
Authors: McGilloway Sinéad , Donnelly Michael 
Published: March 2016

AbstractObjectives: Continuing deinstitutionalisation has led to growing concern about the availability and accessibility of services for people with learning disabilities transferring to community living. This study was undertaken in order to assess the configuration of services in terms of availability and uptake for people with learning disabilities who have left long-stay hospital care and to identify gaps or barriers to service provision within the unique integrated health and social services structure in Northern Ireland.Method: The ‘keyworkers’ of 195 people – most of whom were aged 40-59 years with a diagnosis of moderate intellectual impairment – were interviewed by a researcher one year after discharge using the Service Interview.Results: While a wide range of generic and specialist services was available, ‘packages’ of care consisted largely of public sector services (eg. GPs, chiropodists and social workers) and relied, to some extent, on the type of community accommodation. Although services appeared well co-ordinated in terms of care reviews and keyworker arrangements, 40% of people required more one-to-one support particularly in areas related to integration. However, services were perceived by care staff to be satisfactoryConclusions: The development of community care has been slower in Northern Ireland than elsewhere and a large proportion of resources remain tied up in hospital care. However, existing community-based services appear to be addressing individual needs. Some former patients, though, may have been subject to transinstitutionalisation in the sense that their choice of accommodation was restricted mainly to large private sector homes and work and daytime opportunities were insufficient to facilitate integration. Service planners and providers need to give further consideration to the likely effects of different forms of rehabilitation, reprovision and resettlement and to be aware that the pattern of service provision is likely to be different for the more dependent cohorts of people who leave hospital in the future.
Outcome studies in schizophrenia
Authors: Browne Stephen , Larkin Conall , O'Callaghan Eadbhard 
Published: March 2016

AbstractObjectives:To outline the limitations of traditional studies of outcome in schizophrenia and to review the findings arising from ‘first episode’ psychosis studies.Method:An extensive literature search was performed and relevant papers were examined and analysed.Results:Current knowledge regarding outcome predictors in schizophrenia has primarily been derived from a series of ‘consecutive admission’ and ‘long-term follow-back’ studies. However, methodological considerations may limit the generalisability of these studies' findings. The prospective evaluation of first episode cohorts has advanced our knowledge regarding the relative importance of premorbid and intercurrent factors in determining outcome in schizophrenia.Conclusions:To date, the ‘first episode’ strategy has highlighted some potentially clinically modifiable outcome predictors. These findings may open the way for targeted introduction of measures aimed at preventing poor outcomes in schizophrenia.
Lead encephalopathy secondary to petrol inhalation
Authors: Morgan Maria , Owens John , Pillay Prega 
Published: March 2016

AbstractLead encephalopathy is a relatively rare medical condition. It can present with multiple seizures, delirium, blindness, aphasia and dementia. Usually it is due to environmental exposure. This paper describes a case of delayed diagnosis of lead encephalopathy secondary to petrol sniffing which responded to chelating agents therapy. A high index of suspicion must be maintained to diagnose this treatable cause of encephalopathy.
Completed suicide: an update for the general psychiatrist
Authors: O'Shea Brian , Stokes Marjorie , Falvey Jane 
Published: March 2016

AbstractObjectives: To review the most recent information on completed suicide for the general adult psychiatrist.Methods: Literature review.Results: Suicide is the result of a complex interaction of multiple variables. Prediction is highly dependent on clinical evaluation. Predictive factors identify groups better than individuals. Prevention has both clinical and political implications.Conclusions: Reduced access to lethal methods (historically, from barbiturates to modified vehicle exhaust systems and paracetamol), attention to social factors (such as alcohol availability and employment levels) and clinical vigilance, coupled with adequate treatment of psychiatric disorders and close follow-up, should help to reduce suicide rates. Wider cultural issues (eg. religion) are poorly understood and require further research.
Psychological factors associated with coronary heart disease
Authors: Marusic Andrej 
Published: March 2016

AbstractObjectives: Psychological coronary-proncncss is most probably one of the first recognised risk factors for coronary heart disease (CHD). The mechanisms by which psychological risk factors might exert their influence on the cardiovascular system arc less clear than those for the more standard biological risk factors. The aim of this review was to classify all possible mechanisms of potentiation of CHD by psychological factors.Method: A MEDLINE search was conducted by selecting literature on both standard biological risk factors (eg. dyslipidaemia, hypertension, smoking) and psychological risk factors (eg. personality traits, behavioural characteristics, coping with stress) for CHD.Results: It was suggested that six biological mechanisms could mediate psychological influences specifically for CHD, of course, together with the seventh mechanism of general alterations in health-related behaviours. These are: increased oxygen demand of the heart muscle, decreased blood supply to the heart muscle, increased concentration of blood, enhanced blood clotting, increase in cholesterol and other plasma lipids, disturbances of blood sugar level, and alterations in health-related behaviours.Conclusions: If more studies of CHD were conducted with both physical and psychological risk factors simultaneously, it would be possible to investigate which of the above suggested mechanisms are important, which could in turn substantially improve both primary and secondary preventive measures.
Mental health status of homeless children and their families
Authors: Waldron AnneMarie , Tobin Genevieve , McQuaid Paul 
Published: March 2016

AbstractObjectives: To examine the mental health status of homeless children and their families living in a supported temporary housing project.Method: The assessment measures used: (i) the 28-item General Health Questionnaire (GHQ); (ii) the Child Behaviour Checklist (CBCL); and (iii) the Parenting Stress Index (PSI). The population studied consisted of 14 families and 31 children. Children aged two to 16 years were eligible for the study. Most of the families (12/14) assessed were single parent (mother only) family units.Results: The General Health Questionnaire was completed by the 14 mothers and two fathers. Of the mothers 28% (4/14) indicated the presence of psychiatric ‘caseness’. The Child Behaviour Checklist (CBCL) was completed on 31 children by the mothers. More than a third of the children (12/31) had a Total Problem Score above the ‘clinical’ threshold, indicating the presence of mental health problems of sufficient severity to merit referral for treatment. Of the children 45% (14/31) manifested externalising problems in the ‘deviant’ range, while 29% of the children (9/31) manifested internalising problems in the ‘clinical’ range. In all, when the CBCL scores were examined within each family, 78% (11/14) had at least one child with a CBCL dimension of clinical significance. The Parenting Stress Index was completed by each mother. Of the mothers 70% (10/14) obtained scores in the critical range. They reported feeling incompetent in their parenting role, being dominated by their children's needs and feeling social isolated from their relatives and peers. Their scores also indicated poor self-esteem and significant depressive symptoms. Of note the peak score was the lack of emotional and active support from the other parent.Conclusion: This study revealed a high level of stress and clinical morbidity in this group of homeless mothers and their children and the need to provide appropriate mental health supports and services for them.
Responses of football fans to relegation of their team from the English Premier League: PTS?
Authors: Banyard Philip , Shevlin Mark 
Published: March 2016

AbstractObjectives: To measure the level of psychological distress caused to supporters of a football team by relegation from the English Premier League. The relationship between age, sex and psychological distress are examined.Method: Opportunity sample cross-sectional survey. Participants were approached through networks of fans and through e-mail networks. Participants were supporters (n = 65) of two relegated premiership football teams. Participants completed the Impact of Event Scale.Results: Mean total Impact of Event Scale scores indicated a clinically significant degree of psychological distress for the majority of respondents. Age or sex of the participants did not predict Impact of Event Scale scores.Conclusions: The results are discussed in terms of the magnitude of Impact of Event Scale scores in relation to other stressors. It is concluded that the impact of such sporting events is psychologically significant. The psychological literature has considered traumatic stress responses to a number of stressors such as threats to life, threats to psychological well-being, threats to physical/ psychological well-being of others, witnessing traumatic events and involvement in a human or natural disaster.
Fact or fantasy? A review of recovered memories of childhood sexual abuse
Authors: DelMonte Michael M 
Published: March 2016

AbstractMore than a century ago Freud provoked a bitter controversy concerning alleged recollections of childhood sexual abuse: Were they fact or fiction? This debate is still ongoing, with some professionals stubbornly holding on to deeply entrenched and polarised positions. On the one side there are those who continue to deny the veracity of all ‘recovered memories’, and thus also of the implicated psychological defenses of repression and dissociation. At the other extreme are those therapists who simplistically assume that particular symptoms invariably imply sexual abuse. Over the decades there is a growing corpus of anecdotal, clinical and, more recently, research evidence supporting the contention that childhood sexual abuse, like all other trauma, can be forgotten for days, and even for many years, before being recalled. However, the reconstruction of these memories is a complex and, at times, a rather fallible process.
Assessment following deliberate self-harm: who are we seeing and are we following the guidelines?
Authors: McCauley MacDara , Russell Vincent , Bedford Declan , Khan Ashar , Kelly Roisin 
Published: March 2016

AbstractObjectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.
Trichotillomania
Authors: O'Sullivan Martin J , Redmond H Paul 
Published: March 2016

AbstractTrichotillomania is a relatively uncommon condition that classically occurs in young females. It can result in trichobezoar formation, which is usually managed successfully by surgical intervention, although rarely it can be fatal. This article presents a brief review of trichotillomania. A literature search was performed for ‘trichotillomania’ using the PubMed database, and relevant papers and their references were researched. This review commences by defining the condition and considering its presentation and its prevalence. Diagnostic dilemmas including differential diagnosis and the uncertainty about structural abnormalities in the brain as indicated by magnetic resonance imaging findings are then reviewed. Finally we examine the current treatment options of this interesting condition.
Infanticide and child murder — admissions to the Central Mental Hospital 1850-2000
Authors: Mulryan Niamh , Gibbons Pat , O'Connor Art 
Published: March 2016

AbstractInfanticide and child murders have been known to all civilisations throughout time. This study looks at the problem from an Irish perspective, particularly with regard to the forensic psychiatry service. The case notes and legal files of 64 women admitted to the Central Mental Hospital (CMH), Dublin, between May 1850 and 2000 were examined. This group represents a complete sample of female inpatients charged with these offenses over the 150 year history of the institution. Sociodemographic and clinical data were analysed to provide psychiatric and social backgrounds to the cases. There has been a considerable decrease in the number of women admitted to the CMH on charges or conviction for infanticide and child murder in recent years. It appears that the attitude of the judiciary to these women has altered. The cases are discussed in the context of the prevailing attitudes of the era.
A delusion of immortality – the dilemma of the Struldbruggs
Authors: Cullivan Rachael , Lawlor Brian A 
Published: March 2016

AbstractWe describe a lady with a history of recurrent psychotic depression, together with a persistent delusion of immortality, which appears to be independent of the depressive illness. It is of interest that this woman is a patient of the hospital founded by Dean Jonathan Swift, who described a people stricken with a similar dilemma of unhappy immortality over 200 years ago.
The prevalence of neuroleptic malignant syndrome in learning disability
Authors: Morgan Caryl N , Rowe Renarta 
Published: March 2016

AbstractObjectives: No information has been published on the incidence of neuroleptic malignant syndrome in learning disability. However, some studies of individuals who have developed neuroleptic malignant syndrome have suggested that individuals with learning disabilities may be over represented. This study aims to identify the association between learning disability and neuroleptic malignant syndrome.Method: A retrospective case-note analysis was performed with psychiatric case notes for clients with learning disability, in two geographical catchment areas. It was recorded whether clients had been exposed to neuroleptics, and whether any neurological symptoms had subsequently developed which could have been suggestive of neuroleptic malignant syndrome.Results: It was found that 301 individuals had been exposed to neuroleptics, out of 570 case notes examined. Only one case of neuroleptic malignant syndrome was identified, giving a lifetime prevalence rate of 0.3%.Conclusion: This study failed to demonstrate a higher than expected prevalence of neuroleptic malignant syndrome in clients with learning disability exposed to neuroleptics.
Predictors of discontinuation on clozapine: a population study
Authors: MacGillivray Steve , Cooper Steve J , English Barbara , Millar Helen , Williams Brian 
Published: March 2016

AbstractObjectives: A quarter of people with schizophrenia may be classed as ‘treatment-resistant’. Clozapine is an antipsychotic that holds significant potential benefit for this patient group and has recently been recommended by the National Institute for Clinical Excellence. Early discontinuation is common. This study explores the factors that predict such discontinuation.Method: This retrospective cohort design was carried out on two hundred and one people with treatment resistant schizophrenia who had commenced clozapine between 1990 and 1997 identified from the Clozaril Patient Monitoring Service (CPMS) in Northern Ireland. Clinical and socio-demographic data was collected for three years before and after commencement on clozapine. Kaplan Meier survival analyses were conducted to identify differences in discontinuation rates according to a range of variables.Results: Forty-five per cent of patients had discontinued before three years. No difference in rates were found between men and women, nor whether side-effects were reported or not Patients who had commenced clozapine at an older age had significantly higher cessation rates. People who had started clozapine at age 50+ were four times more likely to stop taking clozapine within three years than people aged between 17-29 years.Conclusions: Differences in continuation rates may be due to a number of factors. Treatment resistance may increase with age, side-effects may worsen or patient willingness to tolerate such effects may reduce. Alternatively, clinicians may be more anxious about prescribing clozapine as levels of co-morbidity increase. Further research is required to identify precise reasons and develop interventions to reduce discontinuation rates among older patients.
Problems experienced by young men and attitudes to help-seeking in a rural Irish community
Authors: Russell Vincent , Gaffney Paul , Collins Katrina , Bergin Aedamar , Bedford Declan 
Published: March 2016

AbstractObjectives: Suicide is now the commonest cause of death among young Irish males. The literature identifies a wide range of contributory risk factors in suicide. However, a number of realities have frustrated clinicians' efforts in the area, including the reluctance of young males to engage in mental health services. In this study, we sought to explore the problems experienced by young men in a rural setting and their attitudes towards seeking help.Methods: Focus groups were employed to generate themes for a qualitative and quantitative questionnaire which was administered to a community sample of 71 young men (22.4% of the total number of males aged 16-30 years in the area) and 79 key informants. The questionnaires contained demographic items and examined available social outlets, types and extent of difficulties experienced by young men and perceptions of and access to potential sources of support.Results: Both young men and key informants reported that peer pressure and alcohol misuse are areas of most difficulty, that friends and family are the preferred sources of support and that young men view much existing professional help as unacceptable.Conclusions: This study provides a basis for the next stage in the research cycle and also supports the viability of building a partnership between the health services and the local community in developing future suicide prevention strategies for young men.