• The therapeutic relationship after psychiatric admission.

      Roche, Eric; Madigan, Kevin; Lyne, John P; Feeney, Larkin; O'Donoghue, Brian; Cluain Mhuire Community Mental Health Service, Dublin, Ireland; †St Vincent's University Hospital, Dublin, Ireland; and ‡Royal College of Surgeons of Ireland, Dublin, Ireland. (2014-03)
      The therapeutic relationship is one of the most central and important factors in the treatment of mental health disorders. A better therapeutic relationship is associated with service engagement, medication adherence, and satisfaction with services. This study aimed to compare the demographic and clinical factors associated with the therapeutic relationship in voluntarily and involuntarily admitted psychiatric service users. We found that individuals who had been admitted involuntarily, who had a diagnosis of a psychotic disorder, and who reported higher levels of perceived pressures on admission were more likely to have a poorer therapeutic relationship with their consultant psychiatrist. Greater levels of insight and treatment satisfaction, together with higher levels of procedural justice experienced on admission, were associated with a better therapeutic relationship. We found that the level of perceived coercion on admission was not related to the therapeutic relationship. Targeted interventions to improve the therapeutic relationship, particularly for involuntarily admitted service users, are discussed.
    • Obsessive compulsive symptoms in patients with schizophrenia on clozapine and with obsessive compulsive disorder: a comparison study.

      Doyle, Mairead; Chorcorain, Aoife Ni; Griffith, Eleanor; Trimble, Tim; O'Callaghan, Eadbard; Cluain Mhuire Mental Health Service, Blackrock, Co. Dublin, Ireland. Electronic address: mairead.doyle@sjog.ie. (2014-01)
      Obsessive compulsive symptoms are commonly reported in those with schizophrenia. Clozapine has previously been reported to induce, aggravate and alleviate these symptoms. It is unclear if these are similar to the symptoms experienced by those with obsessive compulsive disorder. This study describes the obsessive compulsive symptom profile of a population of patients with schizophrenia treated with clozapine (n = 62) and compares this with patients with Obsessive Compulsive Disorder (n = 35). All participants were attending an outpatient community mental health service. The Obsessive Compulsive Inventory (which measures the frequency and associated distress of a range of "behavioural" and "cognitive" symptoms), the Hospital Anxiety and Depression Scale and a demographic questionnaire were completed. In addition the schizophrenia group treated with clozapine completed the Brief Psychiatric Rating Scale. The OCD group reported significantly more symptoms for all OCI subscales compared to the clozapine group. Overall fourteen (22%) of the schizophrenia treated with clozapine group had clinically significant total OCI scores. Two (3%) had documented OCS pre clozapine. De novo OCS was reported in twelve (19%) cases. Nine (11%) had documented OC symptoms pre-clozapine while only two (3%) had symptoms after clozapine was initiated. In terms of OC symptom profile, the clozapine group scored highest on the Doubting scale, a cognitive symptom whereas the OCD group scored highest on Washing, a behavioural symptom. Both groups reported greater distress with cognitive rather than behavioural symptoms. Medication including clozapine dose was not correlated with symptom severity. Anxiety correlated highly with obsessive compulsive symptoms in the Clozapine group but not the OCD group. Within the Clozapine group, Obsessing correlated highly with Unusual Thought Content. Findings suggest that obsessive compulsive symptoms in the Clozapine group may reflect a subtype of 'schizo-obsessive' disorder.
    • Payment of research participants: current practice and policies of Irish research ethics committees.

      Roche, Eric; King, Romaine; Mohan, Helen M; Gavin, Blanaid; McNicholas, Fiona; Cluain Mhuire Community Mental Health Service, Dublin, Ireland. dr.roche.eric@gmail.com (2013-09)
      Payment of research participants helps to increase recruitment for research studies, but can pose ethical dilemmas. Research ethics committees (RECs) have a centrally important role in guiding this practice, but standardisation of the ethical approval process in Ireland is lacking.
    • Service users' perceptions about their hospital admission elicited by service user-researchers or by clinicians.

      O'Donoghue, Brian; Roche, Eric; Ranieri, Veronica F; Shannon, Stephen; Crummey, Ciaran; Murray, Johanna; Smith, Damian G; O'Loughlin, Kieran; Lyne, John P; Madigan, Kevin; et al. (2013-05-01)
      OBJECTIVE Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer-service user-researcher or clinician-influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study. METHODS Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user-researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire. RESULTS A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user-researcher (24% versus 8%, p=.003). CONCLUSIONS Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users' positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user-researchers.
    • Teaching recovery to medical students.

      Feeney, Larkin; Jordan, Iain; McCarron, Peter; Cluain Mhuire Community Mental Health Service, Dublin, Ireland. larkin.feeney@sjog.ie (2013-03)
      Community mental health services are evolving toward more holistic, patient-centered, recovery-based practices. This change necessitates an attitudinal shift from mental health workers, and training in recovery principles is helpful in achieving this change. Medical students often have narrow, doctor-centered concepts of mental health care. Traditional clinical placements in psychiatry do little to address this. We evaluated a recovery-focused teaching program for medical students in psychiatry.
    • A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness.

      Madigan, Kevin; Brennan, Daria; Lawlor, Elizabeth; Turner, Niall; Kinsella, Anthony; O'Connor, John J; Russell, Vincent; Waddington, John L; O'Callaghan, Eadbhard; St. John of God Adult Mental Health Services, Cluain Mhuire Family Centre, Blackrock, Co. Dublin, Ireland; DETECT Early Intervention in Psychosis Service, Blackrock, Co. Dublin, Ireland. kevin.madigan@sjog.ie (2013-01)
      Patients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population.
    • Depression, anxiety and cardiovascular disease: which symptoms are associated with increased risk in community dwelling older adults?

      Gallagher, Damien; O'Regan, Claire; Savva, George M; Cronin, Hillary; Lawlor, Brian A; Kenny, Rose A; Cluain Mhuire Mental Health Services, Blackrock, Co. Dublin, Ireland. gallagherdamien@hotmail.com (2012-12-15)
      Depression is a risk factor for Cardiovascular Disease (CVD). It has been reported that somatic symptoms of depression and not cognitive symptoms are associated with increased risk although findings have been inconsistent. Few studies have examined whether co-morbid anxiety confers additive risk.
    • Prospective relationship of duration of untreated psychosis to psychopathology and functional outcome over 12 years.

      Hill, Michele; Crumlish, Niall; Clarke, Mary; Whitty, Peter; Owens, Elizabeth; Renwick, Laoise; Browne, Stephen; Macklin, Eric A; Kinsella, Anthony; Larkin, Conall; et al. (2012-11)
      The duration of untreated psychosis is well recognised as an independent predictor of symptomatic and functional outcome in the short term and has facilitated the development of worldwide early intervention programmes. However, the extent and mechanisms by which it might influence prognosis beyond a decade remain poorly understood.
    • Audit of thrice- versus twice-weekly ECT.

      Roche, Eric; Lope, Jasmin; Hughes, Helen; McCullagh, Niamh; Larkin, Terence; Feeney, Larkin; Cluain Mhuire Community Mental Health Service, Blackrock, County Dublin, Ireland. ectoroche@gmail.com (2012-09)
      There is a lack of knowledge regarding some basic differences between different electroconvulsive therapy (ECT) treatment schedules.
    • The effects of daily weather variables on psychosis admissions to psychiatric hospitals.

      McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard; St John of God Hospital, Stillorgan, Co. Dublin, Ireland, drstevemb@gmail.com. (2012-08-02)
      Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.
    • Depression and quality of life in first-episode psychosis.

      Renwick, Laoise; Jackson, Deirdre; Foley, Sharon; Owens, Elizabeth; Ramperti, Nicolas; Behan, Caragh; Anwar, Mansoor; Kinsella, Anthony; Turner, Niall; Clarke, Mary; et al. (2012-07)
      Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL.
    • Guidelines reduce time to consultation for a liaison psychiatry service in an Irish teaching hospital.

      Lyne, J; O'Donoghue, B; Bonnar, M; Golden, D; Burke, P; Hill, M; Kinsella, A; McInerney, C; Callanan, I; Ryan, M; et al. (2012-06)
      Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting.
    • A randomised controlled trial of carer-focussed multi-family group psychoeducation in bipolar disorder.

      Madigan, K; Egan, P; Brennan, D; Hill, S; Maguire, B; Horgan, F; Flood, C; Kinsella, A; O'Callaghan, E; Cluain Mhuire Family Centre, Newtownpark Avenue, Blackrock, Co. Dublin and Health Research Board, Dublin 2, Ireland. (2012-05)
      In a RCT of family psychoeducation, 47 carers of 34 patients were allocated to one of three groups; Multifamily Group Psychoeducation, Solution Focussed Group Therapy or Treatment as Usual. Carers in both the MFGP intervention and the SFGP arm demonstrated greater knowledge and reduction in burden than those in the TAU arm.
    • The relationship between insight and neurological dysfunction in first-episode psychosis.

      Hill, M; Crumlish, N; Whitty, P; Clarke, M; Browne, S; Gervin, M; Kinsella, A; Waddington, J L; Larkin, C; O'Callaghan, E; et al. (2012-04)
      Impaired insight is commonly seen in psychosis and some studies have proposed that is a biologically based deficit. Support for this view comes from the excess of neurological soft signs (NSS) observed in patients with psychoses and their neural correlates which demonstrate a degree of overlap with the regions of interest implicated in neuroimaging studies of insight. The aim was to examine the relationship between NSS and insight in a sample of 241 first-episode psychosis patients.
    • Prevalence of item level negative symptoms in first episode psychosis diagnoses.

      Lyne, John; O'Donoghue, Brian; Owens, Elizabeth; Renwick, Laoise; Madigan, Kevin; Kinsella, Anthony; Clarke, Mary; Turner, Niall; O'Callaghan, Eadbhard; DETECT Services, Avila House, Block 5 Blackrock Business Park, Blackrock, Co Dublin, Ireland. johnlyne@mail.com (2012-03)
      The relevance of negative symptoms across the diagnostic spectrum of the psychoses remains uncertain. The purpose of this study was to report on prevalence of item and subscale level negative symptoms across the first episode psychosis (FEP) diagnostic spectrum in an epidemiological sample, and to ascertain whether items and subscales were more prevalent in a schizophrenia spectrum diagnoses group compared to an 'all other psychotic diagnoses' group. We measured negative symptoms in 330 patients presenting with FEP using the Scale for Assessment of Negative Symptoms (SANS), and ascertained diagnosis using the Structured Clinical Interview for DSM IV. Prevalence of SANS items and subscales were tabulated across all psychotic diagnoses, and logistic regression analysis determined which items and subscales were predictive of schizophrenia spectrum diagnoses. SANS items were most prevalent in schizophrenia spectrum conditions but frequently presented in other FEP diagnoses, particularly substance induced psychotic disorder and Major Depressive Disorder. Brief psychotic disorder and bipolar disorders had low levels of negative symptoms. SANS items and subscales which significantly predicted schizophrenia spectrum diagnoses, were also frequently present in some of the other psychotic diagnoses. Conclusions: SANS items have high prevalence in FEP, and while commonest in schizophrenia spectrum conditions are not restricted to this diagnostic subgroup.
    • Treat negative symptoms of schizophrenia early on.

      Lyne, John P; Turner, Niall; Clarke, Mary (2012-03)
    • Can we combine symptom scales for collaborative research projects?

      Lyne, John P; Kinsella, Anthony; O'Donoghue, Brian; DETECT Services, Avila House, Block 5 Blackrock Business Park, Co. Dublin, Ireland. johnlyne@mail.com (2012-02)
      Collaborative research projects have the potential to answer important research questions, which may otherwise require huge resources, funding, and time to complete. There are several scales for measuring psychotic symptoms in schizophrenia and other psychotic disorders, with the Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Symptom Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS) being among the most commonly used. High quality research efforts have used these three scales in different projects, and in order to merge study efforts, some means of combining data from these scales may be necessary. We reviewed correlations in published studies for these three scales, finding them to be highly correlated, however on comparison of the three scales there were considerable clinical differences between them. The paper discusses potential methods for combining the scales in collaborative research, including use of the recently developed standardised remission criteria for schizophrenia.
    • Schizophrenia: a five-year follow-up of patient outcome following psycho-education for caregivers.

      McWilliams, S; Hill, S; Mannion, N; Fetherston, A; Kinsella, A; O'Callaghan, E; DETECT Early Intervention in Psychosis Service, Avila House, Block 5, Blackrock Business Park, Carysfort Avenue, Co. Dublin, Ireland. stephen.mcwilliams@sjog.ie (2012-01)
      There is evidence that psycho-education courses for caregivers of individuals with schizophrenia improve the short-term outcome of the condition. However, most of the outcome studies are limited to two-year follow-up.
    • Group cognitive behavioural therapy as a treatment for negative symptoms in first-episode psychosis.

      Gaynor, Keith; Dooley, Barbara; Lawlor, Elizabeth; Lawoyin, Richard; O'Callaghan, Eadbhard; Schools of Psychology, University College Dublin Cluain Mhuire Service, Blackrock, Ireland. keith.gaynor@gmail.com (2011-05)
      We aimed to test the idea that there is an early critical time period during a psychotic illness when patients may be more responsive to psychological treatment attention.