IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

{"title":"Psychiatrists' views on clozapine prescribing in Ireland.","authors":"A Grant, R McManus, H Belay, M Mahon, F Murad, B O' Donoghue, J Lally","doi":"10.1017/ipm.2024.35","DOIUrl":"https://doi.org/10.1017/ipm.2024.35","url":null,"abstract":"<p><strong>Introduction: </strong>Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study's aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use.</p><p><strong>Methods: </strong>A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland.</p><p><strong>Results: </strong>Twenty-eight percent (<i>n</i> = 77) completed the survey, with 55% of respondents practicing for 15 or more years. Clinicians expressed confidence in managing clozapine treatment and side effects and were well aware of clozapine's clinical effectiveness and guideline-based use. A majority indicated insufficient experience managing rechallenge and half expressed insufficient experience managing adverse events. Perceived patient factors were highlighted as barriers with 69% of respondents reporting patients' concern about effectiveness and 50% regarding tolerability. Sixty-four percent (<i>n</i> = 40) indicated that a specialised/tertiary clozapine service would facilitate initiation, with 57% (<i>n</i> = 36) reporting less frequent blood monitoring would aid clozapine prescribing. A majority identified that access to dedicated staff (81%, <i>n</i> = 51) and dedicated day hospital services (84%, <i>n</i> = 53) would facilitate community initiation.</p><p><strong>Conclusion: </strong>Consultants are familiar with clozapine use and related guidelines. Dedicated staff and facilities for clozapine use is one identified structural change to enhance clozapine prescribing in Ireland. Tertiary service or clinical advice service would assist in clozapine rechallenge cases or in managing significant adverse events. More structured patient education regarding clozapine effectiveness and professional development programmes focused on managing side effects and rechallenge may promote clozapine use.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-7"},"PeriodicalIF":1.8,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362206","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":"General practitioner referrals to a child and adolescent mental health service (CAMHS): pre and post COVID-19 pandemic.","authors":"P FitzPatrick, A George, F Lynch, F McNicholas","doi":"10.1017/ipm.2024.39","DOIUrl":"https://doi.org/10.1017/ipm.2024.39","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the characteristics of GP referrals to CAMHS prior to and over the entire pandemic.</p><p><strong>Methods: </strong>All accepted referrals to a Dublin-based CAMHS between January 1, 2019, and June 30, 2023, were examined. Referral letters were anonymised in batches, and information was extracted directly onto a designated proforma.</p><p><strong>Results: </strong>Before the pandemic (January 2019-February 2020), an average of 17.8 referrals were accepted per month, while during and after the pandemic (March 2020-June 2023), this rose to 18.7 accepted referrals per month. Increases were observed in the clinic's prioritisation of cases during the pandemic period (54.8% v. 41%, <i>p</i> < .001).Referrals post COVID-19 were older (13.1-13.64 years, <i>p</i> = .010) with a higher proportion of females (50.2% v. 62.1%, <i>p</i> < .001). Internalising disorders increased during the pandemic (68.7% v. 78.7%, <i>p</i> = .001), with self-harm referrals also being notably more frequent (18.5% v. 36.3%, <i>p</i> < .001). Referrals for anxiety (43.0% v. 78.2%, <i>p</i> = .004) and eating disorders (0% v.. 6.2%, <i>p</i> < .001) increased significantly. Referrals for psychosis (8.4% v. 4.8%, <i>p</i> = .032) and autism spectrum disorder (ASD) (26.5% v. 18.7%, <i>p</i> = .008) decreased after the onset of the pandemic.</p><p><strong>Conclusions: </strong>Notable increases in referrals for anxiety, depression, self-harm, and eating disorders underscore the impact of the pandemic on youth mental health. Understanding these shifts is crucial for CAMHS to adapt resources and interventions effectively. Clinicians must remain vigilant in assessing and addressing the evolving mental health needs of youths in the post-COVID era, ensuring timely and appropriate interventions, and resources to mitigate long-term consequences.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-5"},"PeriodicalIF":1.8,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356117","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":"A qualitative study exploring the acceptability of a telehealth intervention for family members of people experiencing a first episode psychosis: PERCEPTION.","authors":"David Marshall, Donal O' Keeffe, Megan Carroll, Emily Cleary, Dearbhail Ryan, Eimear Counihan, Sean Naughton, Eoin Geary, Mary Clarke","doi":"10.1017/ipm.2024.37","DOIUrl":"https://doi.org/10.1017/ipm.2024.37","url":null,"abstract":"<p><strong>Objectives: </strong>Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP.</p><p><strong>Methods: </strong>Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives' prior mental health service use experience, and participants' relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were produced: 'Developing confidence in understanding and responding to psychosis'; 'Navigating the small challenges of a broadly acceptable and desirable intervention'; 'Timely support enriches the intervention's meaning'; and 'Dealing with the realities of carer burden'.</p><p><strong>Conclusions: </strong>Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals' preference and needs, may help remove barriers for family members accessing help.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356116","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":"Hexahydrocannabinol (HHC): a potentially potent challenge for Ireland's early intervention in psychosis network.","authors":"Sean Naughton, Mary Clarke","doi":"10.1017/ipm.2024.33","DOIUrl":"https://doi.org/10.1017/ipm.2024.33","url":null,"abstract":"","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1"},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142356118","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":"Mental health of Irish adolescents following the COVID-19 pandemic: results from a population-based cross-sectional survey.","authors":"Niamh Dooley, Emmet Power, Hazel Healy, David Cotter, Mary Cannon","doi":"10.1017/ipm.2024.16","DOIUrl":"https://doi.org/10.1017/ipm.2024.16","url":null,"abstract":"<p><strong>Objectives: </strong>This study provides data on the prevalence of mental health problems among adolescents in Ireland in 2021, toward the end of the COVID-19 pandemic. The importance of having recent, large-scale, mental health data for adolescents has been heightened by COVID-19, the increased demand for child and adolescent mental health services, and the rapidly changing adolescent environment.</p><p><strong>Methods: </strong>As part of the Planet Youth study, a cross-sectional survey of adolescents (<i>N</i> = 4,404), mostly aged 15-16, was conducted between September and December 2021. Participants were recruited from 40 schools and non-traditional educational centres across 3 regions in Ireland, one predominantly urban (North Dublin) and two predominantly rural (Cavan, Monaghan). A range of mental health outcomes were self-reported: a single-item question on mental health; the Strengths & Difficulties Questionnaire (SDQ); depressive and anxiety symptoms from the Symptom Check List 90; the Adolescent Psychotic-like Symptom Screener; and lifetime self-harm, suicidal ideation, and attempt.</p><p><strong>Results: </strong>Over a quarter of adolescents described their mental health as 'bad' or 'very bad' (29%), and had SDQ total problem scores over 20 (26%). Over a third (39%) reported self-harming, 42% reported suicidal ideation, and 11% reported attempting suicide, in their lifetime. Gender-diverse youth (non-binary, trans, and undisclosed) had higher rates of poor mental health outcomes compared to cis-gendered youth (male/female), and females had higher rates of most mental health outcomes compared to males.</p><p><strong>Conclusions: </strong>Many of these estimates suggest a deterioration from previous epidemiological studies. While our findings do not definitively prove youth mental health has worsened over time, these findings are highly concerning. We propose a close monitoring of mental health in future surveys of this population and encourage initiatives to improve the capacity and quality of youth mental health services.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298272","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":"Dementia caregiving during the COVID-19 pandemic: an interpretative phenomenological analysis of caregivers' experiences.","authors":"Marta Pinto-Grau, Alberto Blanco-Campal, Jessica Bramham","doi":"10.1017/ipm.2024.15","DOIUrl":"https://doi.org/10.1017/ipm.2024.15","url":null,"abstract":"<p><strong>Objective: </strong>To explore the lived experience of informal dementia caregivers during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Interpretative Phenomenological Analysis (IPA) was employed. Eight primary informal caregivers were recruited from a community mental health service for older people when attending in their role as caregiver of a service-user. Semi-structured interviews were conducted at home or in the clinic based on the participants' convenience and preference. IPA was completed following Smith and colleagues framework for analysis.</p><p><strong>Results: </strong>Six group experiential themes, each with a number of subthemes, emerged from the cross-case interpretative analysis: the ambivalent experience of caregiving (subtheme: <i>those complex emotional experiences</i>); navigating lockdown: lived challenges and opportunities (subthemes: <i>the pervasive fear</i>, <i>intensification of existing struggles</i>, <i>being prevented from caring for a loved one</i>, and <i>lockdown as a time for opportunity</i>); transitioning out of lockdown (subthemes: <i>regaining freedom, but restricted freedom after all</i> and <i>being in a lockdown of one's own</i>); the present with COVID-19, but mostly with dementia (subthemes: <i>dementia, a disease that does not pause</i>, and <i>'takeaways' from the journey</i>); looking into the future (subthemes: <i>embracing COVID-19</i> and <i>the true needs</i>); and a word on coping (subtheme: <i>managing it all as best one can</i>).</p><p><strong>Conclusion: </strong>Findings demonstrate the significance of the meaning caregivers ascribed to their experiences on their wellbeing and ability to cope in times of COVID-19 and thereafter. Gaining an understanding of the caregivers' unique experiences is crucial to appreciate how to best support them.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298271","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":"Obituary: Professor Ivor Browne, FRCPI FRCPsych MSc (Harv.) DPM.","authors":"B D Kelly","doi":"10.1017/ipm.2024.24","DOIUrl":"https://doi.org/10.1017/ipm.2024.24","url":null,"abstract":"<p><p>Professor William Ivory (Ivor) Browne, consultant psychiatrist, who died on 24 January 2024, was a remarkable figure in the history of medicine in Ireland and had substantial influence on psychiatric practice and Irish society. Born in Dublin in 1929, Browne trained in England, Ireland, and the US. He was chief psychiatrist at St Brendan's Hospital, Grangegorman, Dublin from 1965 to 1994 and professor of psychiatry at University College Dublin from 1967 to 1994. Browne pioneered novel and, at times, unorthodox treatments at St Brendan's. Along with Dr Dermot Walsh, he led the dismantling of the old institution and the development of community mental health services during the 1970s and 1980s. He established the Irish Foundation for Human Development (1968-1979) and, in 1983, was appointed chairman of the group of European experts set up by the European Economic Community for reform of Greek psychiatry. After retirement in 1994, Browne practiced psychotherapy and pursued interests in stress management, living system theory, and how the brain processes trauma. For a doctor with senior positions in healthcare and academia, Browne was remarkably iconoclastic, unorthodox, and unafraid. Browne leaves many legacies. Most of all, Browne is strongly associated with the end of the era of the large 'mental hospital' at Grangegorman, a gargantuan task which he and others worked hard to achieve. This is his most profound legacy and, perhaps, the least tangible: the additional liberty enjoyed by thousands of people who avoided institutionalisation as a result of reforms which Browne came to represent.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-4"},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298273","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 impact of the COVID-19 pandemic on individuals with pre-existing diabetes mellitus.","authors":"A Farrell, K Srikumar, G Farmer, A Liew, B Hallahan","doi":"10.1017/ipm.2024.21","DOIUrl":"https://doi.org/10.1017/ipm.2024.21","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the psychosocial impact of the COVID-19 pandemic on patients with a diagnosis of diabetes mellitus (DM).</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 31 individuals with DM attending a diabetes clinic to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. Anxiety symptoms were correlated with functioning, quality of life and diabetes self-management.</p><p><strong>Results: </strong>Likert data demonstrated that social functioning (mean = 5.5, SD = 3.7) and quality of life (mean = 4.1, SD = 3.1) were most impacted by the COVID-19 pandemic. Anxiety symptoms were prevalent with 13 individuals (41.9%) scoring above cut-off scores for the presence of anxiety symptoms based on the Beck Anxiety Inventory. Diabetes self-management was significantly correlated with functioning (<i>r</i> = 0.51, <i>p</i> = 0.006) and inversely correlated with anxiety symptoms (<i>r</i> = -0.51, <i>p</i> = 0.007). A prior history of a depressive or anxiety disorder was associated with significantly increased anxiety symptoms, as well as impaired global functioning (<i>p</i> < 0.01), poorer self-care of diabetes (<i>p</i> = 0.014) and satisfaction with diabetes treatment (<i>p</i> = 0.03).</p><p><strong>Conclusions: </strong>The psychological and social impact of COVID-19 restrictions on individuals with DM was significant, with poorer management of diabetes correlated with anxiety symptom severity.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-7"},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298274","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":"Climate change and health: the role of health professionals.","authors":"P Crowley, C O'Connor, E Power, M Cannon, D Cotter, F McNicholas","doi":"10.1017/ipm.2024.23","DOIUrl":"https://doi.org/10.1017/ipm.2024.23","url":null,"abstract":"<p><p>Climate change is no longer a problem for future generations and the impact is already taking a toll in many parts of the world. Climate change has already caused substantial, and increasingly irreversible, damage to ecosystems. All these issues combined will inevitably lead to an increase in human suffering and forced displacement. This has significant ramifications for health care systems. In this editorial we outline how climate change is already impacting both physical and mental health. Health professionals have a role to play in addressing this great challenge of our time. Health professionals should reflect on how to promote means of climate change mitigation and adaptation within their spheres of influence - clinical, education, advocacy, administration, and research.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-3"},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298269","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":"Co-designing a virtual reality exposure therapy with students experiencing school anxiety: a proof-of-concept study.","authors":"D Boyle, N Morrin, J Scargill, F Mulvey, C Heavin, E Flanagan, B McMahon, H O'Connell","doi":"10.1017/ipm.2024.22","DOIUrl":"https://doi.org/10.1017/ipm.2024.22","url":null,"abstract":"<p><strong>Background and objectives: </strong>Anxiety related school avoidance can affect up to 5% of a country's students each year. VRET (Virtual Reality Exposure Therapy) is a novel therapy proven to be as effective as conventional approaches for treating many anxiety disorders. The aim of this research is to co-design and evaluate a VRET intervention for students experiencing school related anxiety.</p><p><strong>Method: </strong>Eighteen adolescents participated in design thinking workshops where they developed a script and storyboard for the VRET. Using an iterative approach, a VRET prototype was developed based on this work. Eighteen teenagers were subsequently recruited to engage with the VRET for one session each and provide feedback on their experience via a structured questionnaire (supervised by a study coordinator) particularly focusing on the ability of the VR experience to reduce school related anxiety.</p><p><strong>Results: </strong>Exposure therapy needs to produce an anxiety response to be effective. The VRET was effective in producing an anxiety response in 89% of participants. Results demonstrated that 93% of participants found the simulations immersive, 94% found the scenarios believable, and 83% could relate to 'Dala', the avatar in the videos. 100% of participants believed that VRET would help with school anxiety.</p><p><strong>Conclusion: </strong>This proof-of-concept study demonstrates favourable face validity indicating promise for this mode of intervention for delivering targeted support to anxious students. VRET could be used as a scalable, cost effective early intervention to reduce the severity of anxiety associated with school avoidance.</p>","PeriodicalId":46220,"journal":{"name":"IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE","volume":" ","pages":"1-9"},"PeriodicalIF":1.8,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298270","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}