• Looked after children in Dublin and their mental health needs.

      McNicholas, F; O'Connor, N; Bandyopadhyay, G; Doyle, P; O'Donovan, A; Belton, M; Lucena Clinic, 59 Orwell Rd, Rathgar, Dublin 6. fiona.mcnicholas@sjog.ie (2011-04)
      Children in care in Ireland have increased by 27% in the last decade. This population is recognized to be among the most vulnerable. This study aims to describe their placement histories, service use and mental health needs. Data was obtained on 174 children (56.5% of eligible sample) with a mean age of 10.83 (SD = 5.04). 114 (65.5%) were in care for three years or more. 29 (16.7%) did not have a SW and 49 (37.7%) had no GP 50 (28.7%) were attending CAMHS. Long term care, frequent placement changes and residential setting were significantly related with poorer outcomes and increased MH contact. Given the increase in numbers in care and the overall decrease in resource allocation to health and social care, individual care planning and prioritizing of resources are essential.
    • 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.
    • Multi-element behaviour support as a model for the delivery of a human rights based approach for working with people with intellectual disabilities and behaviours that challenge

      Doody, Christina; Callan Institute for Positive Behaviour Support, St John of God Community Services (Wiley/Blackwell on behalf of British Institute of Learning Disabilities, 2009-12)
    • Nonadherence to medication four years after a first episode of psychosis and associated risk factors.

      Hill, Michele; Crumlish, Niall; Whitty, Petter; Clarke, Mary; Browne, Stephen; Kamali, Moayyad; Kinsella, Anthony; Waddington, John L; Larkin, Conall; O'Callaghan, Eadbhard; et al. (2010-02)
      This study examined concurrent associations and predictors at first indication of nonadherence to antipsychotic medication four years after a first episode of psychosis.
    • 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.
    • Parent information evenings: filling a gap in Irish child and adolescent mental health services?

      McNicholas, F; Lennon, R; Coakley, S; Doyle, P; O'Connor, N; McCourt, M; Byrne, G (2010-02)
      It is estimated that 20% of children experience psychological problems at any one time. 1 Child and adolescent mental health services (CAMHS) in Ireland are under-resourced. Recent economic downturn has hindered the possibility of increased funding to alleviative these deficits. It is now imperative that mental health professionals create innovative and cost effective solutions to promote positive mental health. Recent literature has focused on the benefits of self delivered parenting programmes, with minimal costs incurred. 2,3 Based on the developing evidence supporting self directed approaches, the Lucena Foundation has initiated a series of parent information evenings. These evenings are offered on a monthly basis, and are free to attend. To date 1,538 parents have attended. Feedback from parents has been very positive with 80.5% of them finding them useful or very useful.
    • 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.
    • Person Focused Training: a model for delivering positive behavioural supports to people with challenging behaviours

      McClean, Brian; Dench, Caroline; Grey, Ian; Shanahan, Sean; Fitzsimons, Elaine; Hendler, John; Corrigan, Maria (Wiley-Blackwell, 2005-05)
    • Positive programming - an organisational response to challenging behavior

      McClean, Brian; Walsh, Patrick (Institute for Applied Behavior Analysis, 1995)
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • 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.
    • Treat negative symptoms of schizophrenia early on.

      Lyne, John P; Turner, Niall; Clarke, Mary (2012-03)