IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

{"title":"Treatment of anorexia nervosa in Ireland: striking an ethical balance.","authors":"Eimear Dunne, Art Malone, Hakan Öğütlü, Fiona McNicholas","doi":"10.1017/ipm.2026.10178","DOIUrl":"10.1017/ipm.2026.10178","url":null,"abstract":"<p><p>Anorexia nervosa (AN) is a complex psychiatric illness with severe and life-threatening medical sequelae, including death. Existing evidence-based treatments are linked to good prognosis and full recovery in many. For a small minority of critically ill patients, treatment decisions extend beyond voluntary engagement. Severe cases may involve involuntary hospitalisation, nasogastric feeding, physical restraint, and other coercive measures. While these interventions are sometimes necessary to prevent death, they raise profound ethical concerns. This article explores the ethical tensions in treatment of individuals with AN through the lens of the four principles of biomedical ethics, respect for autonomy, beneficence, non-maleficence, and justice, examining the implications for clinical practice. It also outlines the legal mechanisms in Ireland governing involuntary treatment for AN. It considers treatment principles in children and adolescents as well as adults.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"403-409"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical features of patients who are admitted under different criteria of the Irish Mental Health Act 2001: a retrospective cohort study.","authors":"B W O'Mahony, P Aylward, P Cevikel, B Hallahan, C McDonald","doi":"10.1017/ipm.2024.60","DOIUrl":"10.1017/ipm.2024.60","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the criteria utilised for detaining individuals under the Irish Mental Health Act 2001 (MHA 2001) and their association with clinical features.</p><p><strong>Methods: </strong>Demographic and clinical data of 505 involuntary admissions under the MHA 2001 between 2013 and 2023 were attained. Data included criteria utilised for detention and renewal, sociodemographic and clinical features associated with these criteria, and the use of coercive practices, such as seclusion and restraint.</p><p><strong>Results: </strong>The majority of patients who were involuntarily admitted (61.4%), or had their admission order affirmed by tribunal (78.2%), were not judged to pose an immediate risk to themselves or others. Patients admitted under the \"impaired judgement criterion\" were less likely to be secluded (χ² = 15.8, <i>p</i> < 0.001) or restrained (χ² = 11.6, <i>p</i> < 0.01). Patients admitted under the \"risk criterion\" were younger (KW = 12.7, <i>p</i> = 0.02), and less likely to have a psychotic disorder (χ² = 5.9, <i>p</i> = <0.001) or have a previous involuntary admission (χ² = 7.7, p = 0.02). Patients who were subject to coercive care were younger (U = 12739, <i>p</i> < 0.001), more likely to be male (χ² = 4.6, <i>p</i> = 0.03), and have prolonged involuntary admissions (U = 18412, <i>p</i> = 0.02).</p><p><strong>Conclusions: </strong>Currently, the majority of the involuntary care provided for patients under the MHA 2001 is not related to the risk criterion of causing immediate and serious harm to themselves or others, but rather to the criterion of impaired judgement. Patients admitted under the risk criterion are more often subjected to restrictive practices, but are less likely to suffer from psychosis, than those receiving involuntary care due to their impaired judgement.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"314-322"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical conflicts arising from treatment refusals in psychiatric advance directives: an interview study with mental health professionals.","authors":"Astrid Gieselmann, Anna Werning, Sarah Potthoff, Jochen Vollmann, Jakov Gather, Matthé Scholten","doi":"10.1017/ipm.2025.10086","DOIUrl":"10.1017/ipm.2025.10086","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals' views on ethical conflicts arising from such refusals.</p><p><strong>Objectives: </strong>The objective of this study was to explore professionals' perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.</p><p><strong>Methods: </strong>We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.</p><p><strong>Results: </strong>Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.</p><p><strong>Conclusions: </strong>Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"284-291"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-making capacity in acute care: a psychiatry of later life perspective.","authors":"Mairead Rafferty, Niamh McCarthy","doi":"10.1017/ipm.2025.10165","DOIUrl":"10.1017/ipm.2025.10165","url":null,"abstract":"","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"412"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On what grounds? The legal force of Advance Healthcare Directives for mental health treatment during involuntary admissions under the Mental Health Act, 2001: A retrospective observational study.","authors":"Elaine Joy, Cornelia Carey, Nuala B Kane","doi":"10.1017/ipm.2026.10173","DOIUrl":"10.1017/ipm.2026.10173","url":null,"abstract":"<p><strong>Introduction: </strong>The intersection between the Assisted Decision-making (Capacity) Act 2022 (ADMCA) and the Mental Health Act, 2001 (MHA) has prompted considerable debate. Although not alone in its differential treatment of mental health and physical health advance healthcare directives (AHDs), Ireland is unique in affording legally binding status to mental health AHDs for some but not all inpatient service users detained under mental health legislation. As such, in this study we aim to compare groups of service users for which AHDs would be binding or not at point of detention and to track changes in binding status over the course of admission.</p><p><strong>Methods: </strong>This is a retrospective observational study examining involuntary admissions to a 36 bedded acute psychiatric unit in Dublin from 2021 to 2023. Admissions were grouped into those initially detained on grounds of risk or on the treatment criterion alone, as this would determine binding status of a mental health AHD. We also examined changes to binding status over the course of admission to calculate median bed days when a service user would be entitled to a binding AHD. Descriptive statistics and inferential testing (Chi-squared and Mann-Whitney <i>U</i>) were used to analyse the data.</p><p><strong>Results: </strong>Of 287 admissions of 212 service users, 73.9% admissions were under the treatment criterion alone and would therefore qualify for a binding AHD. We found that diagnosis, mode of detention, and service division were significantly associated with AHD binding status. Service users would qualify for binding AHDs on 83.6% of involuntary bed days and, of those admissions affirmed by the first tribunal, 89.9% would qualify for binding AHDs in the days afterward.</p><p><strong>Conclusion: </strong>Most involuntary service users would qualify for a legally binding AHD under the ADMCA for at least part of their admission. Should AHDs become common practice, binding AHDs will play a significant role in inpatient psychiatric care.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"261-267"},"PeriodicalIF":2.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Speaking through crisis\": experiences of suicidal ideation and emergency care help-seeking among Irish Traveller women.","authors":"James O'Mahony, Leah Quinlivan, Joe Tighe, M Isabela Troya, Katerina Kavalidou","doi":"10.1017/ipm.2026.10221","DOIUrl":"https://doi.org/10.1017/ipm.2026.10221","url":null,"abstract":"<p><strong>Background: </strong>Women from ethnic minorities experience disproportionately high rates of self-harm and suicide. In Ireland, Irish Travellers have an indigenous presence on the island dating back centuries. Although Traveller women are known to be at increased suicide risk, little is understood about their experiences with healthcare during suicidal crisis.</p><p><strong>Aims: </strong>This study sought to explore how Traveller women make sense of their experiences when presenting to emergency departments (EDs) in suicidal crisis, and how they perceive their interactions with clinicians.</p><p><strong>Methods: </strong>Interpretative Phenomenological Analysis (IPA) was employed to capture culturally specific meaning-making around a highly sensitive topic. Two Traveller women were purposively sampled from a deliberately homogeneous subgroup. Each case was analysed independently, followed by a cautious cross-case synthesis to identify shared experiential themes.</p><p><strong>Results: </strong>Two central themes emerged: (1) <i>\"Making sense of Suicidal Behaviours</i>\" captured the women's attempts to understand their actions, the overwhelming emotional pain they endured, and the internal struggle between life and death. (2) <i>\"Impact of Clinicians\"</i> reflected a profound loss of autonomy, with participants feeling controlled and monitored during their care. While some clinicians demonstrated empathy and provided support, others offered limited engagement, leaving participants feeling isolated and frustrated.</p><p><strong>Conclusion: </strong>While idiographic in scope (two cases), the study reflects well-recognised challenges recruiting from acute hospital settings and the impact of limited culturally safe services for Traveller communities. Findings underscore the importance of lived experience-informed, culturally safe, person-centred approaches that recognise the distinct challenges faced by Traveller women during suicidal crisis.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-11"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burnout, depressive, and somatic symptoms in Gaelic Games athletes: the mediating role of resilience.","authors":"Leigh Huggard, Finán Chambers, Finiki Nearchou","doi":"10.1017/ipm.2026.10218","DOIUrl":"https://doi.org/10.1017/ipm.2026.10218","url":null,"abstract":"<p><p>Athletes often experience high rates of burnout, which has known links to depressive/somatic symptoms. However, little is known of the role that resilience plays in shaping these outcomes. The study aimed to examine the mediating role of resilience (personal and relational) in the relationship between burnout (emotional and physical exhaustion, reduced sense of accomplishment, sport devaluation) and depressive/somatic symptoms in Gaelic Games athletes. Participants (<i>N</i> = 225), were invited to an online survey, where they responded to a series of self-report measures and demographic questions. Structural equation modelling was employed to examine the mediating effect of resilience on the relationship between burnout and depressive/somatic symptoms. Findings indicate that interventions promoting relational resilience, such as peer-support initiatives, may protect against the impact of emotional/physical exhaustion on depressive symptoms. However, strategies aimed at developing personal resilience, such as psychological skills training, may reduce the impact of a reduced sense of accomplishment on somatic symptoms.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-6"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Ireland's capacity to meet the mental health care needs of refugees and asylum seekers.","authors":"Teresa Ryan","doi":"10.1017/ipm.2026.10219","DOIUrl":"https://doi.org/10.1017/ipm.2026.10219","url":null,"abstract":"<p><p>Population displacement is a current, accelerating global trend and countries have legal obligations to offer asylum seekers refuge and timely rehabilitation. The mental health of this population is shaped by traumatic experiences, making access to specialist mental health services a critical part of meeting responsibilities. This perspective paper explores Ireland's mental health services for refugees and asylum seekers and finds it insufficiently equipped due to underfunding, workforce shortages, lack of specialist units and insufficient numbers of specialist trained psychotherapists. Comparative European examples indicate that targeted policies, coordinated investment, and specialist workforce are essential to support legal obligations and meaningful integration. These findings aim to prompt Irish policymakers and healthcare providers to consider strategic reform.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-9"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domestic violence and abuse-related suicide: evidence from six years of Irish coronial data.","authors":"Gemma Cox, Elizabeth Cook, Sarah Dangar, Katerina Kavalidou","doi":"10.1017/ipm.2026.10220","DOIUrl":"https://doi.org/10.1017/ipm.2026.10220","url":null,"abstract":"<p><strong>Background: </strong>Suicide and domestic violence and abuse (DVA) represents a critical yet underexplored intersection of public health and social justice in Ireland. This study investigated the prevalence, circumstances, and risk factors associated with suicides with a recorded link to DVA drawing on coronial data from the Irish Probable Suicide Deaths Study (IPSDS 2015-2020).</p><p><strong>Methods: </strong>All cases in the IPSDS (<i>n</i> = 3,622) were screened for documented domestic violence or related indicators. For selected cases, relevant demographic, clinical, psychosocial, and service-contact information was extracted and analysed using reflexive thematic analysis. Composite narratives were developed to synthesise recurrent patterns and present a \"storied account\" of the combined experiences across cases.</p><p><strong>Results: </strong>Fifteen DVA-related suicide cases were identified; all were female. Thus, over the six-year period, 1.7% of suicides among adult women (≥18 years, <i>n</i> = 873) in Ireland were recorded as DVA-related. Multiple adverse experiences were identified among the women including mental health difficulties, substance misuse, physical health conditions, chronic pain, and unemployment. Together, these findings underscore the complexity of suicide prevention in this context. Composite narratives further illustrate how contextual and relational factors interact to shape suicide risk among women with experiences of DVA.</p><p><strong>Conclusion: </strong>Overlapping vulnerabilities and risk factors for women who die by DVA-related suicide present challenges for how \"domestic violence\" is identified and recorded in coronial records. Recommendations for service provision and the coronial system are discussed.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-8"},"PeriodicalIF":2.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148701992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The feasibility of single-session therapy as a point of entry to primary care youth mental health services.","authors":"Jeff Moore, Jim Lyng, Sarah Cullinan, Jason Smith, Conor Boksberger, Alex O'Keffe","doi":"10.1017/ipm.2026.10205","DOIUrl":"https://doi.org/10.1017/ipm.2026.10205","url":null,"abstract":"<p><strong>Background: </strong>The past two decades have seen a rise in youth mental health difficulties, with services struggling to balance demand with capacity. Access to timely care remains a central goal of most national mental health policies. This study examines the feasibility of a model of clinician-delivered single-session therapy (SST) as an entry point to care in primary care youth mental health services.</p><p><strong>Methods: </strong>Conducted at one site, feasibility was assessed across recruitment capacity, service user responses, and intervention acceptability. Validated scales of anxiety and depression evaluated service user characteristics and clinical need, while change across the intervention was measured using the clinical outcomes routine evaluation. Recruitment capacity and user profiles were summarised descriptively. Changes in distress were analysed using linear mixed-effects models and piecewise regression assessed changes in waiting times.</p><p><strong>Results: </strong>Most service users presented with clinical need. Continued throughput and low non-attendance rates indicated feasible recruitment. Waiting times decreased significantly, from 26 weeks during the pilot phase to 4.6 weeks post-implementation (<i>p</i> < 0.001, <i>R</i>² = 0.60). Distress scores differed by session (<i>p</i> < 0.001), with a marked reduction from session 1 to session 2 in the clinical group (Δ = -6.08, <i>p</i> < 0.001). Satisfaction levels remained consistently high pre and post implementation of SST.</p><p><strong>Conclusions: </strong>This feasibility study suggests that SST can be implemented as an acceptable model in primary care youth mental health. Reductions in distress and shorter waiting times were observed following implementation, indicating potential for improved access and early intervention. Further research is required to establish effectiveness, impact and sustainability across settings.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-4"},"PeriodicalIF":2.5,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}