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.

The appropriate monitoring of patients on lithium therapy has been the subject of extensive research in the form of clinical audits and surveys culminating in the development of specific guidelines to help clinicians provide optimal care for patients on lithium. The concept of ‘shared care’ has also gained attention in the literature with various types of shared care interventions being introduced as potential ways of improving communication between primary and secondary care.

This article aims to (1) review the literature evaluating lithium monitoring practices in the United Kingdom and Ireland in the last 25 years and (2) determine whether locally agreed shared care agreements have the potential to improve monitoring quality.

A literature search was conducted using the following databases: PubMed, Scopus, Web of Science, Academic Search Premier, CINAHL and PsychInfo. A total of 12 studies were selected for review including 11 audits/prospective chart reviews and one qualitative study using semi-structured interviews.

Overall, the quality of lithium monitoring seems to be improving throughout the years. However, none of the studies reviewed revealed complete adherence to monitoring guidelines. This may be due to a lack of effective communication between primary and secondary care. Several shared care interventions have been described in the literature but there is a paucity of studies concerned with the effects of local shared care arrangements designed for the specific purpose of lithium monitoring. Nonetheless, the extant data suggests that such agreements may help improve monitoring standards by allowing the responsibilities for managing the prescribing and monitoring of lithium to be more clearly defined and shared between primary and secondary care.

As clinical impartiality is an accepted basic principle of ethical practice, any proactive exercises that may inform selection, training, clinical placements, and other interventions, which promote future positive and equitable professional conduct, thus guarding against future discriminatory attitudes are germane. Within this context, the purpose of this review was to identify trends and patterns in health student, namely future practitioners’, regard for substance-using patients using the Medical Condition Regard Scale.

Six electronic databases were systematically searched for studies that used the Medical Condition Regard Scale as an outcome measure in assessing health student regard for drug-using patients. Academics who had published in this area were also consulted to recommend texts that would complement the above citation sourcing process. Following an elimination of duplicates, the application of inclusion and exclusion criteria, as well as conducting citation searches, 16 studies were incorporated in the final review. Although the quality of all included studies was satisfactory, no study was free from a potential source of bias.

This review found that patients with drug-use problems were consistently held in the lowest echelons of regard by trainee health practitioners. The impact of sex, age, year of course, and personal exposure to mental health difficulties in predicting negative regard was unclear.

Unless addressed, patients with drug problems may have a high potential for future treatment marginalisation by tomorrow’s health professionals. This scenario needs to be proactively managed by all stakeholders through a greater investment in educational and clinical training placement opportunities.

To describe similarities and differences in mental health legislation between five jurisdictions: the Republic of Ireland, England and Wales, Scotland, Ontario (Canada), and Victoria (Australia).

An in-depth examination was undertaken focussing on the process of involuntary admission, review of Admission Orders and the legal processes in relation to treatment in the absence of patient consent in each of the five jurisdictions of interest.

All jurisdictions permit the detention of a patient if they have a mental disorder although the definition of mental disorder varies between jurisdictions. Several additional differences exist between the five jurisdictions, including the duration of admission prior to independent review of involuntary detention and the role of supported decision making.

Across the five jurisdictions examined, largely similar procedures for admission, detention and treatment of involuntary patients are employed, reflecting adherence with international standards and incorporation of human rights-based principles. Differences exist in relation to the criteria to define mental disorder, the occurrence of automatic review hearings in a timely fashion after a patient is involuntarily admitted and the role for supported decision making under mental health legislation.

This study aims to investigate existing evidence for the effectiveness of psychological treatments and/or antidepressant medication as a treatment for those diagnosed with moderate levels of depression.

A PRISMA systematic review of articles using electronic research databases (2000–2014) was conducted to identify studies investigating the effectiveness of psychotherapy and/or medication as a treatment for people with moderate levels of depression. Search terms included moderate depression, psychotherapy and/or medication, depressive disorders, antidepressants, psychotherapy, mental health services, and randomized-controlled trial (RCT). The included studies were then assessed, extracted, and synthesised.

A total of 14 studies met the inclusion criteria (11 RCTs and three additional studies) for this review. The findings of the systematic review indicate that there is limited evidence available specific to the treatment of moderate depression and that this research seems to suggest that psychotherapy or combined treatment has a beneficial effect.

Given that depression is one of the biggest challenges the world faces at present, further research is required to examine the effectiveness of treatment for different levels of depression severity.

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.

An account of the life of pioneer New Zealand psychiatrist Mary Barkas.

At a time when women were rare in psychiatry, New Zealand-born Mary Barkas excelled. A pioneer in the early years of the Maudsley Hospital, Barkas demonstrated her versatility in organic psychiatry, psychoanalysis and child psychiatry. Her career was terminated at an early stage and her life took a puzzling turn after she returned to New Zealand in 1933. Many questions about this intriguing and accomplished psychiatrist need to be explored.

The Mental Health Act 2001 has introduced significant changes to the process of admission to hospital for individuals affected by mental health disorders. This study aimed to determine whether a newly designed smartphone application could result in an improvement in service users’ knowledge of their rights compared with the paper booklet.

This was a randomized study conducted in an outpatient and day-hospital in North Dublin. Participants were randomized to receive the information booklet as either a smartphone application or in the paper form. A questionnaire which was scored from 0 to 10 was devised and was completed at baseline and at 1-week follow-up.

A total of 42 individuals completed the baseline and follow-up questionnaire and of these, 53.7% were female and the mean age was 38.2 years (s.d.±13.5). A total of 34.1% had a diagnosis of a psychotic disorder, 29.3% had a depressive disorder and 22% had bipolar-affective disorder. The mean score before the intervention in the total group was 3.5 (s.d.±2.2) and this increased to 5.8 (s.d.±2.2) at follow-up. Participants randomized to the smartphone application improving by a mean of 2.5 (s.d.±2.5), while those randomized to the booklet improving by a mean of 2.3 (s.d.±2.6), which was not statistically significant.

Both forms of the information booklet showed improvement in service users’ knowledge of their legal rights. It is possible that each individual will have preference for either a paper form or a smartphone form and this study suggests that both forms should be offered to each individual service user.

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.