bluuebunny/crossref_metadata_2025_split huggingface dataset:
Herbal mania: a diagnostic dilemma?
Authors: Kelly Brendan D , Rawlinson Frank , Ogburn Ben 
Published: March 2016

AbstractA case of affective psychosis and cognitive impairment is described. The patient had a history of cerebrovascular disease and had been ingesting large quantities of a complex herbal tonic prior to presentation. Diagnostic issues are discussed. Relevant literature on cerebrovascular disease and herbal remedies is reviewed. We propose a stress-diathesis model to account for this patient's illness and we advise caution in the use of complementary therapies in patients with compromised cerebrovascular status. Appropriate practice guidelines are outlined.
The attitudes of Irish trainees to their training and its supervision: a five-year follow up study
Authors: O'Mahony Edmond , Corvin Aiden 
Published: March 2016

AbstractObjectives: To assess the current attitudes of Irish psychiatric trainees to their training and to determine whether problems identified five years ago have improved.Method: A postal questionnaire was circulated to all identified psychiatric trainees in the eastern region of Ireland over a six-month period in 2000.Results: 153 (62%) trainees responded to the study, and 81% described their training as ‘adequate’ or better. Significant demographic changes over the last five years are recorded. Satisfactory induction, regular supervision and access to tutors are all associated with higher overall satisfaction with training. Sixty-seven per cent report receiving an induction course, but just 40% describe this as satisfactory, and only 49% of trainees receive regular supervision. Specific difficulties in training are reported less frequently than in 1995, but 35% of non-EU doctors report racial discrimination in training and only 59% of trainees received a practical demonstration prior to administering electroconvulsive therapy (ECT).Conclusions: Trainees continue to express high levels of satisfaction with their training. Improvements have been made in a number of key areas, although difficulties remain. For example, regular supervision, which was associated with a positive outlook on training, are unavailable to a majority of trainees.
Outcome of alcoholism in old age
Authors: Johnson Ian 
Published: March 2016

AbstractObjective:This retrospective study describes the follow-up of a birth cohort of alcohol dependent patients as they enter old age. The aim is to define the global outcome of survivors by combining a measure of current drinking behaviour with ratings for depression and dementia.Methods:A series of 100 referrals to a regional unit for alcohol misuse in Bristol, England, were followed up at a mean of 13 years after first referral for treatment. Survivors were traced when they were aged between 67 and 77 years. At follow-up interview, subjects were screened for current alcohol problems, depression and dementia.Results:The mortality rate in the cohort was raised significantly. Almost one third of survivors had depressive symptoms at follow-up and rates of global dementia were higher than expected in an aged-matched sample of the general population. However, the majority of survivors were classified as having an intermediate global outcome with less than 10% having a poor outcome.Conclusions:The high rates of mortality and psychiatric morbidity observed in this cohort illustrate the importance of detecting alcohol problems in the elderly. Further prospective studies are necessary to validate these findings in a community sample of older people.
An audit of admissions to an acute psychiatric unit
Authors: Kelleher Margaret , O'Brien Sinead 
Published: March 2016

AbstractObjectives: In an era of cost containment in the health services, it is important to endeavour to manage existing resources in the optimum way. This study examines admissions to an acute psychiatric unit in a general hospital in order to identify factors that characterise these admissions, which in turn may suggest appropriate interventions.Methods: This was a retrospective casenote review of 105 consecutive admissions. Demographic information and clinical data concerning this admission and service contact in the preceding year was collected. Chi-squared tests were used to compare patients who were admitted during normal working hours with those admitted after 5pm and at weekends. Patients whose length of stay exceeded four weeks were compared with those who had a shorter admission.Results: Eventually 101 patients were included in the study; of these 46.5% of admissions occurred during normal working hours. Admissions outside this time were more likely to be under 45 years (χ2 = 4.05, df = 1, p <0.05) and to be diagnosed with a depressive illness or schizophrenia/psychosis (χ2 = 19.12, df = 3, p <0.05). These admissions were of shorter duration (χ2 = 4.45, df = 1, p <0.05) and had not been in contact with the community psychiatric nurse (CPN) in the preceding year (χ2 = 4.09, df = 1, p <0.05). Length of stay >4 weeks duration was more likely in single patients (χ2 = 9.68, df = 2, p <0.01), those living outside the more urban areas (χ2 = 4.04, df = 1, p <0.05) and those who had a diagnosis of a depressive illness or schizophrenia/psychosis (χ2 = 13.43, df = 3, p <0.01). Patients with a diagnosis of alcohol or substance abuse were spending significantly shorter periods in hospital.Conclusions: Further development of day hospitals is necessary to provide alternatives to inpatient treatment and facilitate earlier discharge for patients living throughout the catchment area. Alternative methods of service delivery such as outreach programmes should be considered for subgroups of patients who are unable or unwilling to access traditional services. Introducing outpatient detoxification programmes would have a substantial impact on admission patterns in the unit.
Hyperactivity and conduct disorder: exploring origins
Authors: Mcardle Paul , O'Brien Gregory , Kolvin Israel 
Published: March 2016

AbstractObjectives: This paper explores the relationship of hyperactivity (HA), conduct disorder (CD) and combined hyperactivity and conduct disorder (HACD) with certain environmental and biological stresses and vulnerabilities.Method: It is based upon a large epidemiological database from the North of England.Results: The findings suggest that CD is uncommon and strongly related to environmental stresses. This is true to a lesser extent of HACD. While both CD and HACD were related to family adversity and adverse styles of parental discipline, subtly different patterns of associations are also evident. In particular, CD is linked with poverty, parental violence and contact with child care social agencies. These findings are consistent with the hypothesis that HA contributes to a pattern of confrontation and punishment associated, in some cases, with the emergence of a more complex combination disturbance. However, CD occurs against a background of family conflict and poor child-care.Conclusions: Most apparent cases of conduct disorder are in fact hybrid conditions including symptoms of HA and CD. True CD should be diagnosed not only by positive symptomatology but also by the absence of hyperactivity symptoms.
Irish Travellers and forensic mental health
Authors: Linehan Sally A , Duffy Dearbhla M , O'Neill Helen , O'Neill Conor , Kennedy Harry G 
Published: March 2016

AbstractObjectives: To determine whether Irish Travellers are over-represented amongst transfers from prison to psychiatric hospital. If so, to determine whether this represents an excess over the proportion of Irish Travellers committed to prison.Method: Irish Travellers admitted to the National Forensic Psychiatry service were identified from a case register over three years 1997-1999. New prison committals were sampled and interviewed as part of the routine committal screening to identify ethnicity.Results: Irish Travellers accounted for 3.4% of forensic psychiatric admissions compared to 0.38% of the adult population. Travellers transferred from prison to psychiatric hospital had more learning disability and less severe mental illness than other groups, while black and other ethnic minorities had a higher proportion of severe mental illness. Travellers accounted for 6% (95% CI 3-11) of 154 male committals and 4% (95% CI 2-12) of 70 female committals. The estimated annualised prison committal rate was 2.8% (95% CI 2.4-3.3) of all adult male Travellers in Ireland and 1% for female Travellers (95% CI 0.8-1.3). Male Travellers had a relative risk of imprisonment compared to the settled community of 17.4 (95% CI 2.3-131.4), the relative risk for female Travellers was 12.9 (95% CI 1.7-96.7). Imprisoned Travellers had greater rates of drugs and alcohol problems than other prisoners (Relative risk 1.46, 95% C11.11-1.90).Conclusion: There is gross over-representation of Travellers in forensic psychiatric admissions. This reflects the excess of Travellers amongst prison committals.
Concordance of clinical estimation of suicidal intent
Authors: Keeley Helen S , McAuliffe Carmel , Corcoran Paul , Perry Ivan J 
Published: March 2016

AbstractObjective:The aim of this paper is to assess the level of agreement between clinical estimates of suicidal intent based entirely on information recorded in the Accident and Emergency acute assessment and Beck's Suicide Intent Scale (SIS) scores.Method:As part of the WHO/EURO Multicentre Study of Parasuicide, cases of deliberate self-harm (DSH) in Cork city hospitals were monitored. Over the period 1995-1997, the information recorded in the Accident and Emergency acute assessment was examined by a psychiatrist and, if possible on the available evidence, clinical estimates were made at three levels of suicidal intent: minimal, moderate and definite. Seventy-nine of these cases had fully completed Beck's SIS. Statistical comparison was made between the results of the SIS and the clinical estimate of suicide intent.Results:The agreement (Kappa = 0.146, p = 0.046) and concordance (Lin's concordance coefficient = 0.330, p = 0.001) between the two ratings are statistically significant but both are low. The overlap between those identified as high or low intent is low.Conclusions:These findings indicate low agreement between a clinician's rating of suicide intent based on clinical records and Beck's SIS. This is especially relevant given the increasing reliance on psychometric instruments in assessment in psychiatry. However, further investigation is necessary to clarify which is the more valid method.
A 15-year follow-up of schizophrenia in Ireland
Authors: Finnerty Aine , Keogh Fiona , O'Grady-Walsh Anne , Walsh Dermot 
Published: March 2016

AbstractObjectives:Psychiatric hospitalisation rates in Ireland have been high. Recent studies indicate that this is not a consequence of raised incidence. This study explored the possibility that poor outcome may have been responsible for this high hospitalisation prevalence.Method:Through participation in the WHO Study, Determinants of Outcome of Severe Mental Disorders (DOSMeD), we followed up a cohort of 67 first-onset schizophrenic patients over 15 years to determine symptomatic and functional outcomes and to compare these with outcomes of the cohorts recruited to the International Study of Schizophrenia (ISoS).Results:Thirty-seven (55%) of the original 67 were successfully followed up over 15 years and, of these, 43% were continuously psychotic for most of the period; a similar proportion had recurrent episodes of illness; two-thirds of subjects had moderate to severe symptoms for most of the time; and, in terms of functional outcome, over four-fifths were unemployed at follow-up.Conclusions:Outcome for the majority of followed-up patients was poor in symptomatic and functional terms. While this outcome was one of the poorest among the DOSMeD groups the question whether functional psychotic illness outcome is inherently poorer in Ireland than elsewhere remains unanswered. The high rate of attrition (45%) from the group during the follow-up period vitiated interpretation of outcome overall. The high number of suicides among the group was noteworthy.
Koro: a case in an Eastern European asylum seeker in Ireland
Authors: Kennedy Noel , McDonough Michael 
Published: March 2016

AbstractKoro is characterised as a perception that one's genital organs are shrinking and will eventually recede into the abdomen. It was initially described in South East Asia as a culture bound syndrome but this syndrome has recently been recognised in a non-culture bound context A case is described of a depressed Eastern European asylum seeker with koro like symptoms. All symptoms resolved completely with fluoxetine treatment The relevant literature to the case is reviewed, in relation to onset, symptoms and treatment of this rare syndrome. In addition comparison is made with previous reports of the non-culture bound variant.
Pharmacological management of treatment resistant depression: a clinical review
Authors: Kennedy Noel , McDonough Michael 
Published: March 2016

AbstractObjectives:Treatment resistant depression (TRD), commonly encountered in clinical practice, leads to socioeconomic disability and therapeutic pessimism. This paper reviews evidence for pharmacological approaches used in TRD.Method:Electronic literature searches were performed using Medline and Psychlit using broad search terms relating to TRD.Results:Agents that potentiate both serotonin and noradrenaline may allow more patients to achieve full remission. Attention must be paid to dose titration and length of treatment courses in TRD. Augmentation with lithium and switching within antidepressant class or between classes can often improve symptoms but efficacy of other augmentation approaches remains uncertain. Antidepressant combinations and addition of atypical antipsychotics can be useful but combinations of predominantly serotonergic antidepressants should be avoided. Electroconvulsive therapy retains an important role in TRD but pharmacological treatments need to be continued concomitantly.Conclusions:Good improvement is seen in TRD after vigorous antidepressant treatment but most patients continue to have lower grade symptomatology.
Antipsychotic drugs: atypical advantages and typical disadvantages
Authors: Wright Padraig , O'Flaherty Luke 
Published: March 2016

Atypical antipsychotic drugs are recommended for the first line treatment of all patients with schizophrenia. This is because it has been demonstrated that atypical antipsychotic drugs are more effective across a broader range of symptoms of schizophrenia than typical antipsychotic drugs and because they are dramatically less likely to cause the extrapyramidal and endocrine side effects that greatly impair quality of life for patients and reduce their willingness to adhere to maintenance treatment. Atypical antipsychotic drugs are not perfect but they are the most effective and the safest treatment for schizophrenia presently available.The atypical antipsychotic drugs currently marketed in Ireland for the first line treatment of schizophrenia include amisulpride, olanzapine, quetiapine, risperidone and ziprasidone. These agents differ somewhat in chemical class, indications, daily dose range, need for titration, daily dosing regimen and available formulations (see Table 1). Clozapine is marketed for patients unresponsive to, or intolerant of, other antipsychotic drugs and must thus be regarded as a second line treatment for schizophrenia. Zotepine is not yet available in Ireland while the marketing of sertindole has been suspended following reports of arrhythmias and sudden cardiac deaths.
An audit of psychotropic prescribing practice of general adult psychiatrists in elderly demented patients
Authors: Meaney Anna Maria , Cooney Colm 
Published: March 2016

AbstractObjectives: In Ireland elderly patients with behavioural and psychological symptoms of dementia (BPSD) are frequently prescribed anti-psychotic and other psychotropic agents. Elderly patients with dementia are more sensitive to adverse effects of medications. Despite this, little is known of the psychotropic prescribing practice of psychiatrists who treat this population. General adult psychiatrists in the Republic of Ireland continue to treat elderly patients with BPSD. The aim of this audit was to identify the prescribing practice of general adult psychiatrists in elderly patients with BPSD. We compare this practice to that of old age psychiatrists in the UK and that recommended by the American Psychiatric Association in 1997.Methods: We devised a structured anonymous questionnaire, which was forwarded to all general adult psychiatrists in the Republic of Ireland.Results: Atypical anti-psychotics are frequently prescribed by general adult psychiatrists to manage BPSD in elderly patients. The anti-psychotic agent of first preference chosen to treat psychotic symptoms in dementia is risperidone. Overall, sedative typical anti-psychotics are still the most frequently chosen anti-psychotic agents, chosen to manage behavioural symptoms in dementia. Benzodiazepines and trazadone are the most frequently prescribed other psychotropic agents chosen to manage agitated behaviour. In general the median doses of antipsychotics and other psychotropic medication used are in keeping with both the APA guidelines and practice of old age psychiatrists in the UK. A minority of practitioners (10%) specified at least one dosage regime that was grossly outside recommended ranges.Conclusions: Overall, prescribing practice in terms of choice of treatment and dosage regime, of general adult psychiatrists in BPSD is in keeping with the best practice guidelines. However, sedating typical anti-psychotics and on occasion extraordinarily high doses of anti-psychotics are still prescribed.
Self-reported alcohol consumption in the Irish community dwelling elderly
Authors: Greene Elaine , Bruce Irene , Cunningham Conal , Coakley Davis , Lawlor Brian A 
Published: March 2016

AbstractObjectives: To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects.Methods: A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable.Results: The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively).Conclusions: As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.
Porphyria and dementia: a case report
Authors: Gibbons Dympna , Cullen Anne , Garland Malcom 
Published: March 2016

AbstractThe porphyrias are a group of rare hereditary metabolic disorders where there is an excess formation and excretion of porphyrins or their precursors. Type IIA, acute intermittent porphyria (AIP), has an estimated prevalence of one to eight per 100,000 in the general population but is thought to have a higher prevalence in psychiatric patients. AIP can present with a variety of psychiatric symptoms, often misdiagnosed. Associated neuropathological changes including focal cerebral ischaemic lesions have been found. However, to our knowledge, no case of dementia and AIP has been described. We present the case of a 56 year old man with a five-year history of progressive cognitive decline, diagnosed with AIP at an advanced stage of dementia. Whether AIP contributed to the dementia or is a coincidental finding is unknown. However treatment of AIP in this case resulted in some improvement in the patient's cognitive state.
The timing of deliberate self harm behaviour
Authors: Blenkiron Paul 
Published: March 2016

AbstractObjectives:To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide.Method:A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done.Results:The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays.Conclusions:Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the ‘broken promise’ effect.
Liaison psychiatry in palliative care
Authors: Payne Ann , Kelleher Michael J , Hayes Yvonne , O'Brien Tony 
Published: March 2016

AbstractObjectives: Psychiatric disorders are common and frequently undetected and under treated in the palliative care population. The aims of this pilot study were determine to: (1) the incidence of psychiatric co-morbidity; (2) the patient's current insight; (3) future fears regarding symptom control; and finally (4) the degree of satisfaction with their doctors level of communication, at the time of their diagnosis.Methods: Over a six-month period, 100 consecutive hospice admissions were assessed by AP, within 72 hours of their arrival. This patient group all had advanced malignant disease. A semi-structured questionnaire was used as a guide (see Table 1) to interview. A full history, cognitive and Mental State Examination (MSE) were performed on each patient.Results: Sixty-four patients were interviewed, 36 were excluded. Sixteen (25%) had a depressive illness, six (9%) had anxiety, 56 (88%) had full or partial insight into their illness. Only eight (12%) were unaware of the nature or implications of their disease. Of those who responded, 19 (30%) felt dissatisfied with how their doctors communicated their diagnosis. A significant proportion, 30 (47%) felt that eventually their symptoms would become out of control.Conclusions: This was a pilot study by a psychiatrist at the bedside in the hospice setting. We found that by concentrating on psychological symptoms rather than the biological, a diagnosis of depression was possible even in these complex medical patients. However, recognition of treatable anxiety in this population is a challenge. Even though 30 (47%) felt that their most distressing symptoms would become out of control during the course of their illness, we found an incidence of anxiety of only six (9%). This suggests that our interview underestimates the true level of anxiety in these patients, and highlights the need for a low threshold for diagnosis and possibly an objective screening mechanism. Regarding the ‘breaking of bad news’, 19 (31%) of patients were dissatisfied and unhappy with this experience and there is clearly room for improvement in communicating a diagnosis of malignancy.