Dialectical behaviour therapy (DBT) is a multi-modal psychological therapy with established efficacy in treating borderline personality disorder (BPD). Younger adults represent a group more likely to drop out of treatment than their older counterparts and treatments specifically targeted at this younger cohort may be advantageous.

We describe an evaluation of a DBT programme in a mental health centre for younger adults 18–25 years who met criteria for BPD (n=11).

We used a simple pre/post-test design, measuring BPD symptoms, general mental health symptoms, and coping skills using self-report questionnaires at the beginning of DBT and again following the delivery of 22 weeks of DBT.

Statistically significant reductions were found in BPD symptoms and several mental health symptoms alongside an increase in DBT skills use. Dropout was 31% at 22 weeks of treatment. Methodological weaknesses and avenues for future research are discussed.

Cognitive behavioural therapy (CBT) has been used in the treatment of alcohol use disorder (AUD), generally in individual or group therapy, but not via computer.

This study examined the effectiveness of an interactive, personalised, computer-based CBT therapy in a randomised control trial.

We studied a group of 55 patients with AUD, randomised to either 5-hour-long computerised CBT sessions or a placebo cognitive-stimulating session, together with a 4-week inpatient rehabilitation treatment, and followed them for 3 months.

There was a high degree of patient adherence to the protocol. Both groups did well, with a significant fall in alcohol outcome measures including number of drinks per drinking day, and number of drinking days, and an increase in abstinence rates in both groups to an equivalent level. The CBT group attended alcoholics anonymous groups more frequently, and had significant alterations in their alcohol self-efficacy outcomes, which correlated with their drinking outcomes. We concluded that computerised CBT is a potentially useful clinical tool that warrants further investigation in different treatment settings for AUD.

To explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.

Postmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.

Recurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.

Individuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.

In children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), the comorbidity of the oppositional defiant disorder (ODD) negatively affects the course of ADHD. The purpose of this study was to compare ADHD-diagnosed children with and without ODD comorbidity in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries.

This study included 109 children diagnosed with ADHD alone and 79 children with the ADHD-ODD comorbidity from a child psychiatry outpatient clinic. The children who participated in the study were aged between 6 and 15 years. Diagnoses of the children were determined by child psychiatrists according to DSM-IV criteria, and the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form was used to support the diagnosis in initial evaluations of children. Forty-six to fifty months after the first admission, parents were questioned regarding all negative outcomes from the time of first diagnosis to the time of the evaluation by phone.

The groups were compared in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries over a period of 4 years. The ODD-ADHD group was determined to have higher rates of disciplinary punishments at school, smoking, and unintentional injuries compared with the ADHD group. No statistically significant difference was found between the two groups in terms of criminal behaviors and psychoactive substance use.

The ODD comorbidity increases the risk of negative outcomes in children diagnosed with ADHD.

The purpose of this pilot study was to evaluate a 12-session group-based motivational intervention for substance misusers in a prison setting. The intervention aimed to increase both participants awareness of problem substance use and motivation to change their substance use behaviour.

Participants were recruited for the intervention through active outreach in the prison. Participants of the intervention group completed a structured interview before the group commencing and standardised pre- and post-outcome measures. The results of the intervention group (n=31) were compared with a waiting list control group (n=11).

Non-parametric analysis showed retention rates on this programme at 2, 4 and 6 weeks were 88%, 79% and 76%, respectively. Outcome data were consistent with the predicted direction for the treatment group compared with the wait-list control with significant between-group differences found on ambivalence and taking steps scores.

This group-based intervention demonstrated positive levels of client engagement and retention. The intervention was also successful in reducing participant ambivalence about their drug use. Implications for service provision are discussed and design limitations of the present study are considered. Overall, findings indicate the potential utility of a group-based motivational intervention for substance misusers in forensic settings.

The system of weekly psychiatric ward rounds is being challenged and multi-disciplinary team meetings (MDTMs) involving inpatients have been developed. These aim to improve integration between medical and social services and increase patient involvement in their care. However, such large meetings are potentially threatening to the patient. This survey aimed to examine inpatient experience of MDTMs and identify factors that significantly alter this experience.

In this cross-sectional survey we assessed patient opinion regarding patient inclusive MDTMs in a psychiatric inpatient unit. A total of 27 participants (response rate 90%) were included. We utilised descriptive statistics and Fisher’s exact test for non-parametric data where appropriate.

In all, 85% (n=23) of patients identified the consultant psychiatrist as a member that they would like to have present at the MDTM. The ward nurse was identified by 63% (n=17) of patients. In all, 48% (n=13) of patients reported feeling anxious/threatened at the MDTM. In all, 70% (n=19) of patients stated that they would have felt less threatened at the MDTM if there were fewer people in attendance. A significant number of voluntary patients (n=11) felt threatened/anxious at the MDTM compared with involuntary patients (n=2) (χ2=4.921, df=1, p=0.026).

The central findings of this study are that patients would prefer fewer people at the MDTM and would feel less threatened/anxious if they participated in selecting those in attendance. These findings suggest that greater patient involvement in preparation for the MDTM could result in a less anxiety filled experience for them.

The aim of the current study was to gain insight into the process of initiation and progression to problematic use among young people who reach clinically significant levels of substance use requiring treatment.

Twenty young people, aged between 15 and 19 years from two different drug treatment centres in Ireland were interviewed regarding their views on their pathway into substance use, their progress to more problematic use, their perception of their parents’ role, if any, in their trajectory and their typical coping style before treatment. Content analysis was conducted on the resulting narratives.

The use of substances to cope with life stressors emerged as a prominent theme at initial and problematic stages of use. Multiple maladaptive coping approaches were reported. Both direct and indirect influences from parents in their substance use problem were cited. However, some participants reported that parents had no causal role in their substance use trajectory, in particular regarding mothers.

The current findings suggest that substance misuse is a multi-determined problem and a number of intervention strategies are suggested to delay onset and related harms associated with adolescent substance use.

Youth mental health services are poised for a paradigm shift. Recent epidemiological evidence confirms the seriousness of adolescence as a risk period for mental ill-health - 50% of all adult mental disorders begin before the age of 16% and 75% before the age of 25. Here, we identify issues with transition of care between CAMHS-AMHS service, and effectiveness of early intervention services.

We provide a selective review providing evidence of adolescence as a risk period, discuss CAMHS-AMHS service transition problems, and discuss avenues for change to implement the early intervention model across youth mental health.

Traditional service structures,with paediatric -adult split at 16–18 years increasingly appear not fit for purpose. A radical redesign of youth mental health services is not only necessary, it is also feasible and achievable, as illustrated by a pilot Birmingham youth service – Youthspace.

Pilot youth mental projects currently underway can help radically redesign the existing child and adolescent services. This will in turn lead to an improvement in the young people's experience of engagement with the services so that they too have a positive future.

There is a strong and growing body of evidence supporting the mental health benefits of music. With regard to Child and Adolescent Mental Health Services (CAMHS) there is a need for creative, child friendly approaches to improve rapport and promote engagement. This study was established as an exploratory pilot project to assess the feasibility of a running a music group within a CAMHS setting as well as any potential benefit to the mental health of a group of diagnostically heterogeneous young people attending the service.

Five young people attending the out-patient clinic participated in a weekly music group over the course of 2 months. Feedback was obtained using a study specific questionnaire as well as baseline and follow-up Strengths and Difficulties Questionnaires.

The music group was described as an enjoyable experience in the clinic setting and young people identified benefits with regard to mood, self-confidence and social skills. Attendance at appointments within the clinic was good for the duration of the group, suggesting a benefit in encouraging engagement.

A music group is a welcome intervention in a CAMHS setting with potential positive benefits for both the service and service users. Further work is needed to establish specific mental health benefits of music-based interventions in young people with mental health difficulties.

Little is known about the involvement of security personnel in Irish psychiatric care. Content analysis of inspection reports is a feasible way to investigate this under-researched topic. We aimed to (i) Describe the number of approved centres per year in which we observed comments about the presence of security personnel in published reports of inspections conducted from 2008 to 2012 (ii) Report the main themes of all text relating to security personnel published in these inspection reports.

We conducted a content analysis of all 349 inspection reports published between 2008 and 2012.

The number of approved centres in which security personnel were noted increased from 3% to 8% between the years 2008 and 2012. This increase was not statistically significant when the same unique centres were compared between years (p=0.684). Employment details such as contracted employment relationship, location relative to the approved centre and hours of work appeared inconsistent across centres. Role functions of security personnel differed across centres and ranged from monitoring the entrance of a unit to observing, restraining and secluding patients. Contrasting perceptions of suitability were evident in the inspection reports. The extent to which the training needs of security personnel were met was unclear from the reports.

Activity of security personnel in psychiatric hospitals may not be role appropriate, compliant with legislation or conducive to treatment. Best practice guidelines should be developed in consultation with multiple stakeholders.

Training in cognitive behavioural psychotherapy (CBT) is expensive both for the students and their funding bodies.

It is important to know how graduates of CBT courses are putting their skills to use, and whether they are continuously updating those skills to achieve best practice. We also wanted to discover the similarities and differences between CBT trainees in the United Kingdom and in the Republic of Ireland (courses in the United Kingdom being analogous to those in Ireland in content and participants).

An internet survey, derived from previous postal questionnaires, was used to enquire into the practice, experience, and continuing professional development of graduates from the CBT courses at Trinity College Dublin.

Most MDT professions were represented in the graduates, preponderantly psychiatrists and mental health nurses, but also including social workers and occupational therapists. Most participants believed that the course had enhanced their careers, and almost half had changed job since graduating. Half said that CBT was now the main focus of their job, but others reported lack of resources, funding, time, and other duties impeded their ability to conduct CBT with clients. However, most participants engaged in continuous professional development regarding CBT, and received CBT clinical supervision.

There was a difference in the proportion of the different professions undertaking this course compared with the United Kingdom and our response rate here was significantly lower. As in UK surveys, participants who may have been supported and funded to undertake the training may not afterwards be supported in implementing their skills in the workplace. The broader implications of this are discussed.

Mindfulness-based cognitive therapy (MBCT) is a group-based intervention similar to mindfulness-based stress reduction, but which includes cognitive therapy techniques. This study investigates its usefulness in the treatment of depressive, anxiety and stress/distress symptoms in cancer patients referred to a psycho-oncology service. It also examines whether effect on depression is mediated by self-compassion.

In phase 1 of this study, 16 cancer patients with mild/moderate psychological distress were randomised to MBCT (n=8) or treatment as usual (TAU; n=8), and assessed pre- and post-treatment. Analysis of variance was performed to examine the effect of treatment on anxiety and depression. In phase 2, the TAU group received the intervention, and results of pre- and post-MBCT assessments were combined with those receiving MBCT in phase 1. Finally, both groups were followed up at 3 months.

In phase 1, the MBCT group had a significant improvement in mindfulness and a decrease in anxiety. Statistically significant improvements in both depression and anxiety were found at 3 month follow-up. Self-compassion appeared to mediate the effect on anxiety/depression.

This small pilot study suggests that MBCT may have a beneficial effect on psychological variables often adversely affected in cancer in a heterogeneous cancer population.

There has been a recent move in psychiatry towards the use of electronic discharge (e-discharge) summaries in an effort to improve the efficiency of communication between primary and secondary care, but there are little data on how this affects the quality of information exchanged.

To evaluate the quality of psychiatric discharge summaries before and after the introduction of the e-discharge summary system.

A retrospective analysis of 50 dictated discharge summaries from 1 January to 1 July 2010 and of 50 e-discharge summaries from 1 January to 1 July 2012, evaluating for the inclusion of 15 key items of clinical information.

The average total score of the dictated summaries (mean=9.5, s.d.=2.0) was significantly higher (p<0.001) than the e-discharge summaries (mean=6.7, s.d.=1.8). There were statistically significant differences in five of the standards: findings of physical examination (p<0.001), ICD-10 code (p<0.001), forensic history (p<0.001), alcohol history (p<0.001) and drug history (p<0.001).

Our results revealed a decline in the quality of discharge summaries following the introduction of an electronic system. The reasons for this are unclear and require further analysis. Specific suggestions will depend on the local need, but include improvements in software design and layout as well as better education and training.

We aimed to examine the association between childhood trauma and functional impairment in psychotic disorders, bipolar disorder and borderline personality disorder, to speculate on possible mechanisms that underlie this association and discuss the implications for clinical work.

Narrative review of the peer-reviewed English language literature in the area.

High rates of childhood trauma in psychotic disorders, bipolar disorder and borderline personality disorder were identified. This was associated with impaired social and occupational functioning in both the premorbid and established phases of each of these psychiatric disorders over and above the deficits typically observed in these populations. Possible mechanisms mediating this relationship include neurocognitive deficits, insecure attachment, higher rates of comorbidities and problems with adherence and response to treatment.

Routine clinical inquiry about childhood maltreatment should be adopted within mental health settings. This has potentially important treatment implications for identifying those individuals at elevated risk of functional disability. While there is no clear guidance currently available on how to target childhood trauma in the treatment of psychotic disorders, bipolar disorder or borderline personality disorder, there are several promising lines of enquiry and further research is warranted.

The aim of this study was to improve the quality of prescription writing in a long-term psychogeriatric inpatient unit by a combination of serial audits and interventions designed to address the identified deficiencies.

We undertook three clinical audits of the prescription sheets used in an inpatient unit providing continuing care for residents with severe and enduring mental illness and dementia. Based on the findings of the first audit a set of prescribing guidelines was implemented into the ward. Following the second audit a new prescription sheet was developed. The format of the new prescription sheet was designed to account for the needs of the unit and to adhere to Irish and UK best practise guidelines. Two months after its introduction we undertook a third audit.

Completion of the drug sensitivity box increased from 25% at audit one to 100% at audit three. Other specific aspects of prescription writing that had been poor at the beginning of the audit cycle also showed improvement: prescribing of generic psychotropic drugs increased by 69% and inclusion of the prescribers Medical Council Registration Number increased by 78%. However, some basic aspects of prescription writing remained weak such as frequency of drug administration and documentation of the stop/review date for ‘as required’ medication.

The results of this study suggest that clinical audit and feedback can improve the quality of prescriptions in an in-patient setting.