• 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)
    • The ethical issues surrounding consent and capacity

      Dornan, J; Kennedy, M; St. Patrick's University Hospital, Dublin (Irish Psychiatrist, 2010)
    • Ethnic identity, perceptions of disadvantage, and psychosis: findings from the ÆSOP study.

      Reininghaus, Ulrich; Craig, Thomas K J; Fisher, Helen L; Hutchinson, Gerard; Fearon, Paul; Morgan, Kevin; Dazzan, Paola; Doody, Gillian A; Jones, Peter B; Murray, Robin M; et al. (2010-12)
      Many studies have shown that rates of psychosis are elevated in the Black and minority ethnic (BME) population in the UK. One important, but relatively less researched explanation of these high rates may be social adversity associated with acculturation processes. Strong identification with an ethnic minority group subjected to social disadvantage may exert adverse effects on individuals from BME groups. Using data from a large epidemiological case-control study of first-episode psychosis, we aimed to investigate whether strong ethnic identification is a factor contributing to the excess of psychosis in BME groups compared with the White British, after adjustment for perceptions of disadvantage. All cases with a first episode of psychosis presenting to specialist mental health services within tightly defined catchment areas in London and Nottingham, UK, and geographically matched community controls were included in the study. Data were collected on socio-demographic and clinical characteristics, perceptions of disadvantage, and identification with one's own ethnic group. Analysis was performed on data from 139 cases and 234 controls. There was evidence that, as levels of ethnic identification increased, the odds of psychosis increased in the BME but not in the White British group, independent of potential confounders. However, the association between strong ethnic identity and psychosis in BME individuals was attenuated and non-significant when controlled for perceived disadvantage. Strong identification with an ethnic minority group may be a potential contributory factor of the high rates of psychosis in the BME population, the effects of which may be explained by perceptions of disadvantage.
    • Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample.

      Morgan, C; Fisher, H; Hutchinson, G; Kirkbride, J; Craig, T K; Morgan, K; Dazzan, P; Boydell, J; Doody, G A; Jones, P B; et al. (2009-03)
      We sought to investigate the prevalence and social correlates of psychotic-like experiences in a general population sample of Black and White British subjects.
    • An evoked auditory response fMRI study of the effects of rTMS on putative AVH pathways in healthy volunteers.

      Tracy, D K; O'Daly, O; Joyce, D W; Michalopoulou, P G; Basit, B B; Dhillon, G; McLoughlin, D M; Shergill, S S; CSI Lab, Department of Psychological Medicine, The Institute of Psychiatry, King's College London, UK. d.tracy@iop.kcl.ac.uk (2010-01)
      Auditory verbal hallucinations (AVH) are the most prevalent symptom in schizophrenia. They are associated with increased activation within the temporoparietal cortices and are refractory to pharmacological and psychological treatment in approximately 25% of patients. Low frequency repetitive transcranial magnetic stimulation (rTMS) over the temporoparietal cortex has been demonstrated to be effective in reducing AVH in some patients, although results have varied. The cortical mechanism by which rTMS exerts its effects remain unknown, although data from the motor system is suggestive of a local cortical inhibitory effect. We explored neuroimaging differences in healthy volunteers between application of a clinically utilized rTMS protocol and a sham rTMS equivalent when undertaking a prosodic auditory task.
    • Examining evidence for neighbourhood variation in the duration of untreated psychosis.

      Kirkbride, J B; Lunn, D J; Morgan, C; Lappin, J M; Dazzan, P; Morgan, K; Fearon, P; Murray, R M; Jones, P B; Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK. jbk25@cam.ac.uk;St. Patrick's University Hospital Dublin (2010-03)
      Family involvement in help-seeking is associated with a shorter duration of untreated psychoses [DUP], but it is unknown whether neighbourhood-level factors are also important.
    • Expression of the neuronal adaptor protein X11alpha protects against memory dysfunction in a transgenic mouse model of Alzheimer's disease.

      Mitchell, Jacqueline C; Perkinton, Michael S; Yates, Darran M; Lau, Kwok-Fai; Rogelj, Boris; Miller, Christopher C J; McLoughlin, Declan M; MRC Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, London, UK. (2010)
      X11alpha is a neuronal-specific adaptor protein that binds to the amyloid-beta protein precursor (AbetaPP). Overexpression of X11alpha reduces Abeta production but whether X11alpha also protects against Abeta-related memory dysfunction is not known. To test this possibility, we crossed X11alpha transgenic mice with AbetaPP-Tg2576 mice. AbetaPP-Tg2576 mice produce high levels of brain Abeta and develop age-related defects in memory function that correlate with increasing Abeta load. Overexpression of X11alpha alone had no detectable adverse effect upon behavior. However, X11alpha reduced brain Abeta levels and corrected spatial reference memory defects in aged X11alpha/AbetaPP double transgenics. Thus, X11alpha may be a therapeutic target for Alzheimer's disease.
    • Extra information about treatment is too much for the patient with psychosis.

      Kennedy, Miriam; Dornan, Julieanne; Rutledge, Emer; O'Neill, Helen; Kennedy, Harry G; Central Mental Hospital, Dublin, Ireland. (2011-04-27)
      Case law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.