Improving monitoring for metabolic syndrome using audit.

Audit has been defined as "a quality improvement process that seeks to improve patient care and outcome, through systematic review of care and comparison with explicit criteria, followed by the implementation of change". As of May 2011, under the Medical Practitioners Act 2007, doctors are legally obliged to join in professional competence schemes, following requirements set by the Medical Council. These include the obligation for doctors to conduct one clinical audit per year.

Recovery from mental illness: changing the focus of mental health services.

The concept of recovery entered the lexicon of the mental health services in the 1980s following the publication of a series of studies and personal narratives which demonstrated that the course of mental illness was not always one of inevitable deterioration and that people diagnosed with severe mental illness could reclaim or recover meaningful lives. For a long time, recovery was not thought possible by many family members, service providers and researchers. However globally, specific policy and clinical strategies are being developed to implement recovery principles although key questions remain.

Two-year study of the use of neuroimaging in a psychiatric inpatients unit.

Objectives: Neuroimaging is being used increasingly in the investigation of psychiatric disorders. Previous studies have found abnormalities in about two-thirds of all scans done in psychiatry. The aim of our study was to investigate the use of CT and MRI in the management of inpatients in psychiatry department Adelaide & Meath hospital, Tallaght and to examine the relationship between diagnosis and abnormalities seen on scans.

The spectrum of worry in the community-dwelling elderly.

Objectives: In this study, we examine the prevalence and distribution of worry, its content, and its associations with quality of life and depression, based on a large sample of community-dwelling elderly. We will attempt to distinguish between pathological and non-pathological worry based on these associations.

Design: Community survey.

Big boys don't cry: male secondary school students' attitudes to depression.

Objectives: In an earlier qualitative study we explored the attitudes of young men aged 15-19 (Group A) to mental health and, in particular, to engaging with the various mental health services available. We found that the participants perceived stigma in connection with mental ill health and they displayed particularly strong negative attitudes in relation to both doctors and medication. The investigation was then repeated with students who had been given a short (less than two-hour) programme called 'Beat the Blues' (BTB) about mental health (Group B) in order to assess the effect of that exposure by comparing the attitudes of the two groups of students.

CPR in the nursing home: fool's errand or looming dilemma?

Background: 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.

ECT: An investigation of lay attitudes and experiences in an Irish sample.

Objectives: Electroconvulsive therapy (ECT) is one of the most controversial psychiatric treatments of the modern era. Few studies have used validated scales to examine attitudes and knowledge regarding ECT in lay people. We examined attitudes, knowledge and experience of ECT using standardised questionnaires in Irish lay people, and compared the present results with the findings from a similar study reported over 25 years previously.

Catatonia - case report and review.

Catatonia is a neuro-psychiatric disorder that can occur in medical, psychiatric and drug-induced conditions but is often unrecognised. A 64 year-old woman was admitted to hospital for assessment of a significant deterioration in her ability to communicate and function normally so that she had become completely dependent on others for all activities of daily living for nearly three years. Outpatient medical and psychiatric assessments failed to clarify diagnosis.

Predictive factors for relapse after an integrated inpatient treatment programme for unipolar depressed and bipolar alcoholics.

Aim: The aim of this study was to examine prospectively examined predictors of relapse in alcohol dependence with comorbid affective disorder.

Methods: One hundred and eighty-three unipolar depressed or bipolar alcoholics who completed an integrated inpatient treatment programme for dual diagnosis were assessed at baseline, post-treatment discharge and at 3 and 6 months post treatment. Backwards stepwise likelihood ratio multiple logistic regression was used to investigate the impact of multiple covariates on relapse to alcohol in the 0-3- and 3-6-month period post discharge.

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

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.

Comparison of referrals from primary and secondary care to CMHT psychologists.

Objectives: To explore whether (direct) referrals from GPs to two Community Mental Health Team (CMHT) clinical psychologists differed from those received from both 'Psychiatric' (eg. consultant psychiatrists) and 'Other' sources.

Method: The two psychologists retrospectively examined and coded the case files of all clients who attended them during a 12-month period.

Social support network structure in older people: underlying dimensions and association with psychological and physical health.

Social networks have been associated with a wide variety of health outcomes in older people. We examined the dimensions underlying the Wenger social support network type assessment to identify dimensions associated with mental and physical health. We interviewed 1334 community-dwelling participants aged 65+.

Loneliness, social support networks, mood and wellbeing in community-dwelling elderly.

Objective: Both loneliness and social networks have been linked with mood and wellbeing. However, few studies have examined these factors simultaneously in community-dwelling participants. The aim of this study was to examine the relationship between social network, loneliness, depression, anxiety and quality of life in community dwelling older people living in Dublin.

Electroconvulsive therapy, capacity and the law in Ireland.

The Mental Health Act (MHA) 2001 has major implications for treating patients with electroconvulsive therapy (ECT), especially as those referred for treatment are among the most severely ill and often lose capacity. Under the MHA 2001, a person may only be treated without consent if they are an involuntary patient. However, there is no provision in the Act for treating voluntary inpatients whose mental state has deteriorated but who do not seek to leave hospital.

Mental health consequences of child sexual abuse.

Survivors of child sexual abuse (CSA) can experience a variety of long-term mental health effects on their life trajectory, which brings them to the attention of mental health services. It is vital that the mental health nurse remains aware of the mental health consequences of CSA and receptive towards patients' efforts to disclose a history of CSA. Moreover, fundamentally, the mental health nurse should endeavour to consider his/her own personal feelings on this emotive subject.

Prediction of patient survival by healthcare professionals in a specialist palliative care inpatient unit: a prospective study.

Accurate prognostication is an enormous challenge for professionals caring for patients with advanced disease. Few studies have compared the prognostic accuracy of different professional groups within a hospice setting. The aim of this study was to compare the ability of 5 professional groups to estimate the survival of patients admitted to a specialist palliative care unit.

Influence of ethnicity on presentation and outcome of first episode psychosis.

We describe a young African male presenting to an Irish psychiatric service with first episode psychosis with an acute onset, no prodromal features and early and complete remission. Migrant and ethnic minority groups may differ in their clinical presentation, course and outcome of psychosis compared with the Caucasian population. This has implications for assessment and treatment of ethnic minority patients in an Irish context given the recent migration into a previously homogeneous population.

Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis program.

Background: Depressed and bipolar alcoholics represent a significant affective subgroup that has a poorer prognosis than either diagnosis alone. To date few systematic treatment programs have been developed to treat dual diagnosis.

Methods: An inpatient treatment program was developed at St Patrick's Hospital Dublin to treat dual diagnosis clients with alcohol dependence and either unipolar or bipolar affective disorder.