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Balint groups are now mandatory for psychiatry trainees. Balint groups have been in existence in General Practice for several decades. Providing Balint groups for Psychiatry Non Consultant Hospital Doctors brings with it challenges for the group leader and participants. Many of these challenges are common place in any form of group work, while others are unique to this cohort. This article describes these challenges. Guidelines which offer the the group the best chance of success, in the face of these common challenges, are discussed.
The Eating Disorder Examination Questionnaire (EDE-Q) is a self-report questionnaire that is used to identify probable cases of eating disorders. Norms are needed for interpretation of scores. The aim of this study is to establish norms for the EDE-Q among female university students attending a university primary health care service in Ireland and to present prevalence of key eating disorder behaviours.
The EDE-Q was administered to a consecutive sample of 200 female students aged 18–30 years attending a university primary health care service.
The mean global EDE-Q score was 1.51 (s.d.=1.28). There was a positive association between body mass index and the global EDE-Q score; 5.8% of the sample scored in the clinically significant range on the global EDE-Q score.
This study presents normative EDE-Q data for an Irish female university sample. These norms may inform clinicians and/or researchers in the evaluation of EDE-Q scores in Irish female university students
Few studies have described clinical characteristics of patients subject to an involuntary detention in an Irish context. The Irish Mental Health Act 2001 makes provision under Section 23(1), whereby a person who has voluntary admission status can be detained.
This study aimed to describe all involuntary admissions to St Patrick’s University Hospital (SPUH) (2011–2013) and to evaluate clinical characteristics of voluntary patients who underwent Mental Health Act assessment during 2011 to determine differences in those who had involuntary admission orders completed and those who did not.
All uses of Mental Health Act 2001 within SPUH 2011–2013 were identified. All uses of Section 23(1) during 2011 were reviewed and relevant documents/case-notes examined using a pro forma covering clinical data, factors recognized to influence involuntary admissions and validated scales were used to determine diagnoses, insight, suicide and violence risk.
Over 2011–2013, 2.5–3.8% of all admissions were involuntary with more detained after use of Section 23(1) than Section 14(2). The majority of initiations of Section 23(1) did not result in an involuntary admission (72%), occurred out of hours (52%) and many occurred early after admission (<1 week, 43%). Initiation of Section 23(1) by a consultant psychiatrist (p=0.001), suicide risk (p=0.03) and lack of patient insight into treatment (p=0.007) predicted conversion to involuntary admission.
This study predicts a role for patient insight, suicide risk and consultant psychiatrist decision making in the initiation of Mental Health Act assessment of voluntary patients. Further data describing the involuntary admissions process in an Irish setting are needed.
The EOLAS programme is a peer and clinician-led mental health information programme on recovery from mental health difficulties, specifically for people with a diagnosis of schizophrenia spectrum or bipolar disorders, their family members and significant others.
This article, the first of a two part series, outlines the background to and the rationale behind the EOLAS programme, and traces the participatory process used to inform the development and implementation of the pilot phase of the project. The aims of the programme, and the overarching principles that guided its development, delivery and evaluation, including the set-up of the project steering group are outlined and discussed.
Two separate programmes, one for family members and one for service users were designed. In addition, participant and facilitator handbooks were developed for each programme, including a training programme for facilitators.
Central to a recovery oriented service is the involvement of service users and families in the design and delivery of services. EOLAS is one potential model for achieving this aim.
The present study evaluated the impact on psychosocial outcome of parallel clinician and peer-led information programmes for people with a diagnosis of schizophrenia and bipolar disorder and for family members within an Irish context.
A sequential mixed method design was used. Quantitative data were collected using pre- and post-programme questionnaires followed by an integrated qualitative component involving semi-structured interviews after the programme. The questionnaires assessed knowledge, attitudes towards recovery, hope, support, advocacy and well-being. Interviews with participants, facilitators and project workers explored their experiences and views of the programme.
While a number of the questionnaires did not show a statistically significant change, findings from the interviews suggest that the1 programmes had a number of positive outcomes, including increases in perceived knowledge, empowerment and support. Participants in both programmes valued the opportunity to meet people in similar circumstances, share their experiences, learn from each other and provide mutual support.
The EOLAS programmes offer a novel template for communication and information sharing in a way that embodies the principles of collaboration and offers users and families a meaningful opportunity to become involved in service design, delivery and evaluation.
Effective transition from child and adolescent mental health services (CAMHS) to adult services is one of the main challenges currently facing child psychiatry today
The Young Adult 1Programme (YAP) based at St. Patrick’s University Hospital Dublin, is a group based day programme especially designed to meet the needs of younger people aged 18–25 and support them through this difficult period.
To examine the effectiveness of participation in YAP for young adults with mental illness. To determine whether participation in particular aspects of the programme prove more beneficial and what factors might be associated with outcome.
All patients enrolled in YAP between 1 September 2011 and 31 August 2012 were included in the study. Each patient was assessed using the Health of the Nation Outcome Scales (HONOS) and Global Assessment of Functioning (GAF) rating scale before beginning the programme and after discharge in order to evaluate improvement. The frequency of attendance at individual group sessions was recorded. Patient and illness variables were also recorded, for example demographics, diagnosis.
A total of 101 service users were in enrolled in YAP during this 12-month period. Eight service users could not be used for analysis, as they did not have a complete data set, mostly due to failure to attend for discharge HONOS/GAF ratings
Using a paired sample t-test, there is a significant reduction in HONOS: Mean df=1.3, s.d.=1.09 (95% CI=1.08–1.53), p<0.001
Using a paired sample t-test, there is a significant increase in GAF: Mean df=9.25, s.d.=7.69 (95% CI=7.66–10.83), p<0.001
Improvements in HONOS and GAF scores are significantly correlated with better attendance at the programme (p<0.04, <0.00 respectively).
More attendance at YAP sessions correlates with better improvement in both HONOS and GAF rating scores.
Antipsychotics have proven benefits in children and adolescents with autism spectrum disorders. However, notwithstanding some therapeutic benefits significant side effects are associated with the use of antipsychotics, such as hyperprolactinaemia. We completed an audit cycle between April 2013 and December 2013 to evaluate the practice in the Beechpark Autism Service with respect to monitoring and managing hyperprolactinaemia in children and adolescents prescribed antipsychotics. The re-audit assessed whether the recommended guidelines and changes had been implemented. The National Institute for Health and Care Excellence guidelines were used as a gold standard for this audit.
Basal determinations of serum prolactin improved significantly at the end of the audit cycle (28.6% v. 57%) with slight improvement in six monthly repeat prolactin monitoring (28.6% v. 39.1%) showing some change in clinical practice. However, there was minimal improvement in managing hyperprolactinaemia (0% v. 12.5%).
There is growing awareness about hyperprolactinaemia associated with the use of antipsychotic medication in children and adolescents and the long-term effects. Clear documented guidelines will help increase and improve the monitoring and management of hyperprolactinaemia in these groups of patients. However, more needs to be done in improving the practice of monitoring and managing hyperprolactinaemia in children and adolescent prescribed antipsychotic medication giving the documented long-term effects.
We report the case of a 52-year-old male with pre-motor Huntington’s disease (HD) who has undergone detailed clinical and neuropsychological examination. This patient’s negative symptomatology and behavioural change are having a detrimental impact on his social, occupational and interpersonal life, in the absence of motor symptoms.
The patient has undergone repeat neuropsychological testing (T1 aged 50; T2 aged 52) with particular focus on executive function and social cognition on repeat testing.
This case details a specific manifestation of HD relating to behavioural, psychiatric and social affective deficits.
This case illustrates how social cognitive changes can occur in HD, months and even years prior to the onset of motor features and how such unrecognized deficits can have a deleterious impact on an individual’s functional ability and lifestyle, before the disease is traditionally considered to have become manifest.
To review the available clinical guidelines from Canada, North America, Europe and the United Kingdom for the diagnosis and management of attention-deficit hyperactivity disorder (ADHD) for adolescents previously diagnosed in Child and Adolescent Mental Health Services (CAMHS) on transition to Adult Mental Health Services (AMHS) and for adults presenting with a diagnostic query re-ADHD. This article seeks to apply the available guidelines to an Irish context.
Various clinical guidelines and consensus statements were identified by a literature search of PubMed, incorporating literature from the past 10 years from English speaking countries and inclusion of any additional guidelines of clinical relevance. A clinical guideline with specific reference for Irish clinicians was proposed for the diagnosis and management of adults presenting for the first time with a diagnostic query re-ADHD and also to include those young adults previously diagnosed in CAMHS on transition to AMHS.
ADHD is a lifelong disorder, which if undiagnosed or untreated can lead to significant impairment resulting in a high economic cost for society. Stimulant medication is a first-line treatment option for adults with ADHD; however, some formulations are unlicensed in Ireland. Recent licensing of Atomoxetine, for both adolescents on transition and for adults with newly diagnosed ADHD is a welcome development. Third-line agents are rarely prescribed due to their side effect profiles and are prescribed off-label:
It is important to establish clinical guidelines for an Irish context incorporating a biopsychosocial approach. Further discussion amongst clinicians and stakeholders is needed to plan service development.
Daniel Frederick Rambaut was a prominent asylum doctor in the late 19th and early 20th century. Of Irish and Huguenot origins, his career brought him from the Richmond Asylum in Dublin to the Resident Medical Superintendent position at the largest private hospital in England. In his student years at Trinity, he was a central figure in a groundbreaking rugby match.