• Agrammatism in a case of formal thought disorder: Beyond intellectual decline and working memory deficit.

      Semkovska, Maria; Department of Psychiatry TCD, St. Patrick's Hospital, Dublin, Ireland. semkovsm@tcd.ie (2010-02)
      Previous studies have suggested that naming and syntactic deficits in formal thought disorder may be related to global cognitive decline. This article reports the case of a patient, FM, with formal thought disorder schizophrenia who presents disproportionate deficits in receptive and expressive grammar with respect to his intellectual level of functioning. Syntactic and morphologic components of expressive grammar appeared equally impaired. Deficits in language comprehension were observed independently from working memory limitations. FM showed preserved grammaticality judgment, but defective sentence comprehension where semantic context does not provide heuristics for assigning thematic roles, but syntactic knowledge is essential. These atypical results are discussed within a neurodevelopmental aetiological model of formal thought disorder.
    • Amyotrophic lateral sclerosis mutant vesicle-associated membrane protein-associated protein-B transgenic mice develop TAR-DNA-binding protein-43 pathology.

      Tudor, E L; Galtrey, C M; Perkinton, M S; Lau, K-F; De Vos, K J; Mitchell, J C; Ackerley, S; Hortobágyi, T; Vámos, E; Leigh, P N; et al. (2010-05-19)
      Cytoplasmic ubiquitin-positive inclusions containing TAR-DNA-binding protein-43 (TDP-43) within motor neurons are the hallmark pathology of sporadic amyotrophic lateral sclerosis (ALS). TDP-43 is a nuclear protein and the mechanisms by which it becomes mislocalized and aggregated in ALS are not properly understood. A mutation in the vesicle-associated membrane protein-associated protein-B (VAPB) involving a proline to serine substitution at position 56 (VAPBP56S) is the cause of familial ALS type-8. To gain insight into the molecular mechanisms by which VAPBP56S induces disease, we created transgenic mice that express either wild-type VAPB (VAPBwt) or VAPBP56S in the nervous system. Analyses of both sets of mice revealed no overt motor phenotype nor alterations in survival. However, VAPBP56S but not VAPBwt transgenic mice develop cytoplasmic TDP-43 accumulations within spinal cord motor neurons that were first detected at 18 months of age. Our results suggest a link between abnormal VAPBP56S function and TDP-43 mislocalization.
    • Annual report & financial statements 2010

      St Patrick's University Hospital (St Patrick's University Hospital, 2011-11-09)
    • Annual report and financial statements

      St Patrick's University Hospital (2010-08-06)
    • Annual report and financial statements 2008

      St Patrick's University Hospital (2009-07-21)
    • Assessment of posttraumatic symptoms in patients with first-episode psychosis.

      Schäfer, Ingo; Morgan, Craig; Demjaha, Arsime; Morgan, Kevin; Dazzan, Paola; Fearon, Paul; Jones, Peter B; Doody, Gillian A; Leff, Julian; Murray, Robin M; et al. (2011-11)
      Posttraumatic stress disorder is common among patients with psychotic disorders. The present study examined the internal reliability and comparability of the Impact of Event Scale (IES) in a sample of 38 patients with first-episode psychosis and 47 controls exposed to severe physical and/or sexual abuse. The IES total score and both subscales showed high internal consistency in both groups (Cronbach's alpha coefficients of approximately 0.9 or higher). Given their equivalent trauma reporting, the lack of differences in IES scores between patients and controls seems to indicate that patients are likely to report accurately and neither exaggerate nor minimize their posttraumatic symptoms. Overall, the findings suggest that the IES can be used to assess symptoms of posttraumatic stress in patients with psychotic disorders as in other populations.
    • Childhood trauma and cognitive function in first-episode affective and non-affective psychosis.

      Aas, Monica; Dazzan, Paola; Fisher, Helen L; Morgan, Craig; Morgan, Kevin; Reichenberg, Abraham; Zanelli, Jolanta; Fearon, Paul; Jones, Peter B; Murray, Robin M; et al. (2011-06)
      A history of childhood trauma is reportedly more prevalent in people suffering from psychosis than in the general population. Childhood trauma has also been linked to cognitive abnormalities in adulthood, and cognitive abnormalities, in turn, are one of the key clinical features of psychosis. Therefore, this study investigated whether there was a relationship between childhood trauma and cognitive function in patients with first-episode psychosis. The potential impact of diagnosis (schizophrenia or affective psychosis) and gender on this association was also examined.
    • Combining dimensional and categorical representation of psychosis: the way forward for DSM-V and ICD-11?

      Demjaha, A; Morgan, K; Morgan, C; Landau, S; Dean, K; Reichenberg, A; Sham, P; Fearon, P; Hutchinson, G; Jones, P B; et al. (2009-12)
      There is good evidence that psychotic symptoms segregate into symptom dimensions. However, it is still unclear how these dimensions are associated with risk indicators and other clinical variables, and whether they have advantages over categorical diagnosis in clinical practice. We investigated symptom dimensions in a first-onset psychosis sample and examined their associations with risk indicators and clinical variables. We then examined the relationship of categorical diagnoses to the same variables.
    • A comparison of brief pulse and ultrabrief pulse electroconvulsive stimulation on rodent brain and behaviour.

      O'Donovan, Sinead; Kennedy, Mark; Guinan, Blaithin; O'Mara, Shane; McLoughlin, Declan M; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland. (2012-04-27)
      Brief pulse electroconvulsive therapy (BP ECT; pulse width 0.5-1.5ms) is a very effective treatment for severe depression but is associated with cognitive side-effects. It has been proposed that ultrabrief pulse (UBP; pulse width 0.25-0.30ms) ECT may be as effective as BP ECT but have less cognitive effects because it is a more physiological form of neuronal stimulation. To investigate this further, we treated normal rats with a 10 session course of either BP (0.5ms), UBP (0.3ms), or sham electroconvulsive stimulation (ECS) and measured antidepressant-related changes in dentate gyrus cell proliferation and hippocampal BDNF protein levels as well as hippocampal-dependant spatial reference memory using the water plus maze and immobility time on the forced swim test. Both BP and UBP ECS induced very similar types of motor seizures. However, BP ECS but not UBP ECS treatment led to a significant, near 3-fold, increase in cell proliferation (p=0.026) and BDNF levels (p=0.01). In the forced swim test, only BP ECS treated animals had a significantly lower immobility time (p=0.046). There was a trend for similarly reduced hippocampal-dependent memory function in both BP and UBP groups but overall there was not a significant difference between treatment and control animals when tested 10 days after completing allocated treatment. These findings show that, even though both forms of ECS elicited similar motor seizures, UBP ECS was less efficient than BP ECS in inducing antidepressant-related molecular, cellular and behavioural changes.
    • CPR in the nursing home: fool's errand or looming dilemma?

      Lyons, D; Gormley, N; Zulfiquar, W; Silverman, M; Philpot, M; St. Patrick's Hospital, James's Street, Dublin 8, Ireland. dlyons@stpatsmail.com (2011-09)
      The indications for CPR (cardiopulmonary resuscitation) have expanded greatly since the technique was introduced and theoretically it can be attempted on all prior to death. Policy initiatives (such as the British Medical Association/Royal College of Nursing guidelines) have attempted to provide a clinical rationale for the withholding of inappropriate CPR. Traditionally a care home was felt to be an inappropriate environment to attempt CPR but increased use of advance directives may bring the issue to the fore in this setting.
    • Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis.

      Hodgins, Sheilagh; Calem, Maria; Shimel, Rhiannon; Williams, Andrew; Harleston, Dionne; Morgan, Craig; Dazzan, Paola; Fearon, Paul; Morgan, Kevin; Lappin, Julia; et al. (2011-02)
      Persons with severe mental illness (SMI) are at increased risk of criminal offending, particularly violent offending, as compared with the general population. Most offenders with SMI acquire convictions prior to contact with mental health services. This study examined offending among 301 individuals experiencing their first episode of psychosis.
    • Dialectical behaviour therapy-informed skills training for deliberate self-harm: a controlled trial with 3-month follow-up data.

      Gibson, Jennifer; Booth, Richard; Davenport, John; Keogh, Karen; Owens, Tara; Department of Psychology, St Patrick's University Hospital, James's Street, Dublin 8, Ireland. Electronic address: jgibson@stpatsmail.com. (2014-09)
      Dialectical Behaviour Therapy (DBT) has been shown to be an effective treatment for deliberate self-harm (DSH) and emerging evidence suggests DBT skills training alone may be a useful adaptation of the treatment. DBT skills are presumed to reduce maladaptive efforts to regulate emotional distress, such as DSH, by teaching adaptive methods of emotion regulation. However, the impact of DBT skills training on DSH and emotion regulation remains unclear. This study examined the Living Through Distress (LTD) programme, a DBT-informed skills group provided in an inpatient setting. Eighty-two adults presenting with DSH or Borderline Personality Disorder (BPD) were offered places in LTD, in addition to their usual care. A further 21 clients on the waiting list for LTD were recruited as a treatment-as-usual (TAU) group. DSH, anxiety, depression, and emotion regulation were assessed at baseline and either post-intervention or 6 week follow-up. Greater reductions in the frequency of DSH and improvements in some aspects of emotion regulation were associated with completion of LTD, as compared with TAU. Improvements in DSH were maintained at 3 month follow-up. This suggests providing a brief intensive DBT-informed skills group may be a useful intervention for DSH.
    • Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis.

      Morgan, K D; Dazzan, P; Morgan, C; Lappin, J; Hutchinson, G; Chitnis, X; Suckling, J; Fearon, P; Jones, P B; Leff, J; et al. (2010-07)
      African-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients.
    • A double-blind, placebo-controlled study of sertraline with naltrexone for alcohol dependence.

      Farren, Conor K; Scimeca, Michael; Wu, Ran; Malley, Stephanie O; Yale University School of Medicine, Department of Psychiatry, Substance Abuse Treatment Unit, 1 Long Wharf, New Haven, CT 06419, United States. cfarren@stpatsmail.com (2009-01-01)
      Significant preclinical evidence exists for a synergistic interaction between the opioid and the serotonin systems in determining alcohol consumption. Naltrexone, an opiate receptor antagonist, is approved for the treatment of alcohol dependence. This double-blind placebo-controlled study examined whether the efficacy of naltrexone would be augmented by concurrent treatment with sertraline, a selective serotonin receptor uptake inhibitor (SSRI).
    • Early interventions for people with psychotic disorders

      Power, P; McGorry, PD; St. Patrick's University Hospital, Dublin (Oxford University Press, 2011)
    • The economic cost of pathways to care in first episode psychosis.

      Heslin, Margaret; McCrone, Paul; Flach, Clare; Fearon, Paul; Morgan, Kevin; Jones, Peter; Murray, Robin M; Dazzan, Paola; Doody, Gill; Morgan, Craig; et al. (2011)
      Few studies have examined the economic cost of psychoses other than schizophrenia and there have been no studies of the economic cost of pathways to care in patients with their first episode of psychosis. The aims of this study were to explore the economic cost of pathways to care in patients with a first episode of psychosis and to examine variation in costs. Data on pathways to care for first episode psychosis patients referred to specialist mental health services in south-east London and Nottingham between 1997-2000. Costs of pathway events were estimated and compared between diagnostic groups. The average costs for patients in south-east London were £54 (CI £33-£75) higher, compared to patients in Nottingham. Across both centres unemployed patients had £25 (CI £7-£43) higher average costs compared to employed patients. Higher costs were associated with being unemployed and living in south-east London and these differences could not be accounted for by any single factor. This should be considered when the National Health Service (NHS) is making decisions about funding.
    • Electroconvulsive therapy and nursing care.

      Kavanagh, Adam; McLoughlin, Declan M; Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland. (2011-04-27)
      Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.
    • Electroconvulsive therapy, brain stimulation and neurosurgery for mental illness

      Dunne, R; McLoughlin, D.M.; St. Patrick's University Hospital, Dublin (Elsevier, 2010)