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6 results

  • Psychotropic medicines’ prevalence, patterns and effects on cognitive and physical function in older adults with intellectual disability in Ireland: longitudinal cohort study, 2009–2020

  • Marina Odalović, Ashleigh Gorman, Aviejay Paul, Philip McCallion, Éilish Burke, Malcolm MacLachlan, Mary McCarron, Martin C. Henman, Maeve Moran, Juliette O'Connell, Michael Walsh, Rohit Shankar, Caitriona Ryan, Máire O'Dwyer
  • Journal:
    BJPsych Open / Volume 10 / Issue 2 / March 2024
    Published online by Cambridge University Press:
    01 February 2024, e39
    • Article
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  • Background

    The frequent prescribing of psychotropics and high prevalence of polypharmacy among older adults with intellectual disabilities require close monitoring.

    Aims

    To describe change in prevalence, predictors and health outcomes of psychotropic use during the four waves (2009/2010, 2013/2014, 2016/2017, 2019/2020) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA).

    Method

    Eligible participants were adults (≥40 years) with intellectual disabilities who participated in all four waves of IDS-TILDA and who reported medication use for the entire period. Differences between groups were tested using Cochran's Q test for binary variables and the McNemar–Bowker test for variables with more than two categories. Generalised estimating equation models were used to assess associations between psychotropic use, participants’ characteristics and health outcomes.

    Results

    Across waves (433 participants) there were no significant differences in prevalence of psychotropic use (61.2–64.2%) and psychotropic polypharmacy (42.7–38.3%). Antipsychotics were the most used subgroup, without significant change in prevalence between waves (47.6–44.6%). A significant decrease was observed for anxiolytics (26.8–17.6%; P < 0.001) and hypnotics/sedatives (14.1–9.0%; P < 0.05). A significant increase was recorded for antidepressants (28.6–35.8%; P < 0.001) and mood-stabilising agents (11.5–14.6%; P < 0.05). Psychotropic polypharmacy (≥2 psychotropics) was significantly associated with moderate to total dependence in performing activities of daily living over the 10-year period (OR = 1.80, 95% CI 1.21–2.69; P < 0.05).

    Conclusions

    The study indicates an increase in usage of some classes of psychotropic, a reduction in others and no change in the relatively high rate of antipsychotic use over 10 years in a cohort of older adults with intellectual disabilities and consequent risk of psychotropic polypharmacy and medication-related harm.

  • Still Too POSH to Push for Structural Change? The Need for a Macropsychology Perspective

  • Malcolm MacLachlan
  • Journal:
    Industrial and Organizational Psychology / Volume 10 / Issue 3 / September 2017
    Published online by Cambridge University Press:
    30 August 2017, pp. 403-407

  • My mother, who lived her early years in the British Raj in India, assures me that POSH referred to the well-to-do European's wish to travel “Port Out, Starboard Home” on ships to and from India, which meant enjoying the predominantly shaded side of the ship, protected from the ravaging heat that “ordinary” folk had to endure. What an apt, provocative, and profound analogy Gloss, Carr, Reichman, Abdul-Nasiru, and Oestereich (2017) have given us in their description of the primary focus of industrial and organizational (I-O) psychology on “Professional, Official, Secure, and High income” work.

  • 4 - Psychology and cultural psychiatry

  • from Part I - Theoretical background
    • By Malcolm MacLachlan, Centre for Global Health and Department of Psychology Trinity College Dublin Dublin 2 Ireland, Sieglinde McGee, School of Psychology Trinity College Dublin Dublin 2 Ireland
  • Edited by Dinesh Bhugra, Institute of Psychiatry, London, Kamaldeep Bhui
  • Book:
    Textbook of Cultural Psychiatry
    Published online:
    11 August 2009
    Print publication:
    18 October 2007, pp 43-58

  • Summary

    EDITORS' INTRODUCTION

    Psychology as a discipline focuses on the study of human behaviour in different settings; its relationship with psychiatry in general has been one of healthy tension, even though biopsychosocial models of aetiology and management emphasise psychological factors as one of the three prongs along with biological and social factors. Psychology emerged in the Eurocentric tradition, even though mental illnesses and abnormal behaviours had been described for centuries across cultures. The relationship between psychology and cultural psychiatry has been infected by mutual suspicion. The suspicion is due to several reasons, including political imperatives on both sides. Cross-cultural psychology as a discipline aims to provide localized cultural perspective and comparative cultural perspectives, and is a relatively recent development. Psychology focuses on both the individual and their development, and the consequences in response to their actions.

    MacLachlan and McGee emphasize that psychology focuses on the smallest unit in society – the individual – and on how the individual's life experiences and characteristics influence health and the experience is seen as central to but not independent of cultural factors. The relationship between medical anthropology, medical sociology and clinical/health psychology is of great interest in trying to make sense of the practice of cultural psychiatry. Describing the development of Problem Portrait Technique, which seeks to convey a likeness of a person's presenting problems through both words and images, is one way of trying to understand a person's inner experience. Some of these questions are fairly similar to questions asked while exploring explanatory models, and this technique gives the clinician a complete outline of causal factors that a more conventional approach to assessment may have overlooked.