• Epidemiological and clinical characterization following a first psychotic episode in major depressive disorder: Comparisons with Schizophrenia and Bipolar I Disorder in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS).

      Owoeye, Olabisi; Kingston, Tara; Scully, Paul J; Baldwin, Patrizia; Browne, David; Kinsella, Anthony; Russell, Vincent; O'Callaghan, Eadbhard; Waddington, John L; Cavan-Monaghan Mental Health Service, Cavan General Hospital & St Davnet's Hospital, Monaghan, Ireland; (Oxford Journals, 2013-05-28)
      While recent research on psychotic illness has focussed on the nosological, clinical, and biological relationships between schizophrenia and bipolar disorder, little attention has been directed to the most common other psychotic diagnosis, major depressive disorder with psychotic features (MDDP). As this diagnostic category captures the confluence between dimensions of psychotic and affective psychopathology, it is of unappreciated heuristic potential to inform on the nature of psychotic illness. Therefore, the epidemiology and clinical characteristics of MDDP were compared with those of schizophrenia and bipolar disorder within the Cavan-Monaghan First Episode Psychosis Study (n = 370). Epidemiologically, the first psychotic episode of MDDP (n = 77) was uniformly distributed across the adult life span, while schizophrenia (n = 73) and bipolar disorder (n = 73) were primarily disorders of young adulthood; the incidence of MDDP, like bipolar disorder, did not differ between the sexes, while the incidence of schizophrenia was more common in males than in females. Clinically, MDDP was characterized by negative symptoms, executive dysfunction, neurological soft signs (NSS), premorbid intellectual function, premorbid adjustment, and quality of life similar to those for schizophrenia, while bipolar disorder was characterized by less prominent negative symptoms, executive dysfunction and NSS, and better quality of life. These findings suggest that what we currently categorize as MDDP may be more closely aligned with other psychotic diagnoses than has been considered previously. They indicate that differences in how psychosis is manifested vis-à-vis depression and mania may be quantitative rather than qualitative and occur within a dimensional space, rather than validating categorical distinctions.
    • Impact of patient suicide on front-line staff in Ireland.

      Gaffney, Paul; Russell, Vincent; Collins, Katrina; Bergin, Aedamar; Halligan, Paddy; Carey, Clionadh; Coyle, Sabrina; HSE Child & Adolescent Mental Health Service, Drumalee Cross, Cavan, Ireland. paulg.gaffney@hse.ie (Death studies, 2009-08)
      Research and anecdotal evidence suggests that coming to terms with the suicide of a patient can be extremely distressing for front-line professionals. Some research also suggests that exposure to such situations can undermine professionals' functioning and feelings of competence, cause them to question their professional standing and ultimately contribute to burnout. A survey of 447 front-line professionals' experiences of patient suicide was undertaken to further explore these issues. Thematic analysis of open-ended questionnaire items revealed that concerns for the bereaved family, feelings of responsibility for the death and having a close therapeutic relationship with the client are key factors that influence the adjustment and coping of a health professional in the aftermath of the death of a client by suicide. The results are discussed with a focus on the impact of suicide on front-line staff, the need for ongoing support and training and the development of specific post-suicide protocols.