IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

Objectives: To examine the clinical and demographic profile of inpatient psychosis admissions in Ireland.

Methods: Anonymised data was extracted from the Health Research Board (HRB) National Psychiatric Inpatient Reporting System (NPIRS) from 2013-2022. The NPIRS database is maintained by the HRB and records all admissions to inpatient units and hospitals on the register of approved centres under the Mental Health Act 2001. Data was reviewed and analysed using SPSS V26.

Results: There were 43,963 psychosis admissions over the 10-year period corresponding to 26% of all psychiatric admissions. Males accounted for 58% of psychosis admissions. The median age at first admission was 36 years of age for males and 42 years of age for females. Median length of stay in days was longer for psychosis admissions (median = 20 days IQR = 8-43) than for other mental health disorders (median = 13 days IQR = 4.0-33).

Conclusions: Understanding the clinical and demographic profile of psychosis related inpatient psychiatric admissions in Ireland provides insights that can inform effective service planning and care delivery. The findings of this study have particular relevance for the implementation and evolution of the Health Service Executive Early Intervention in Psychosis Clinical Programme.

Objectives: To examine the criteria utilised for detaining individuals under the Irish Mental Health Act 2001 (MHA 2001) and their association with clinical features.

Methods: Demographic and clinical data of 505 involuntary admissions under the MHA 2001 between 2013 and 2023 were attained. Data included criteria utilised for detention and renewal, sociodemographic and clinical features associated with these criteria, and the use of coercive practices, such as seclusion and restraint.

Results: The majority of patients who were involuntarily admitted (61.4%), or had their admission order affirmed by tribunal (78.2%), were not judged to pose an immediate risk to themselves or others. Patients admitted under the "impaired judgement criterion" were less likely to be secluded (χ² = 15.8, p < 0.001) or restrained (χ² = 11.6, p < 0.01). Patients admitted under the "risk criterion" were younger (KW = 12.7, p = 0.02), and less likely to have a psychotic disorder (χ² = 5.9, p = <0.001) or have a previous involuntary admission (χ² = 7.7, p = 0.02). Patients who were subject to coercive care were younger (U = 12739, p < 0.001), more likely to be male (χ² = 4.6, p = 0.03), and have prolonged involuntary admissions (U = 18412, p = 0.02).

Conclusions: Currently, the majority of the involuntary care provided for patients under the MHA 2001 is not related to the risk criterion of causing immediate and serious harm to themselves or others, but rather to the criterion of impaired judgement. Patients admitted under the risk criterion are more often subjected to restrictive practices, but are less likely to suffer from psychosis, than those receiving involuntary care due to their impaired judgement.

This paper explores the intersection of physical health and recovery-oriented approaches in psychosis, offering a unique perspective through autoethnography. By combining personal experience with a broader analysis of existing mental health frameworks, the paper highlights the often overlooked importance of physical health in the recovery process for individuals with psychosis. The autoethnographic narrative reveals the complex challenges posed by antipsychotic medications, including weight gain and metabolic complications, and their impact on overall well-being. It emphasizes the dual stigma of mental health challenges and weight gain, highlighting the need for a more integrated, holistic approach to mental health care. Recommendations include enhanced education for healthcare providers, personalized care plans, and a multidisciplinary approach aimed at bridging the gap between physical and mental health in psychosis recovery.

Objectives: There is evidence of increasing rates of hospital presentations for suicidal crisis, and emergency departments (EDs) are described as an intervention point for suicide prevention. Males account for three in every four suicides in Ireland and are up to twice as likely as females to eventually die by suicide following a hospital presentation for suicidal crisis. This study therefore aimed to profile the characteristics of ED presentations for suicidal ideation and self-harm acts among males in Ireland, using clinical data collected by self-harm nurses within a dedicated national service for crisis presentations to EDs.

Methods: Using ED data from 2018-2021, variability in the sociodemographic characteristics of male presentations was examined, followed by age-based diversity in the characteristics of presentations and interventions delivered. Finally, likelihood of onward referral to subsequent care was examined according to presentation characteristics.

Results: Across 45,729 presentations, males more commonly presented with suicidal ideation than females (56% v. 44%) and less often with self-harm (42% v. 58%). Drug- and alcohol-related overdose was the most common method of self-harm observed. A majority of males presenting to ED reported no existing linkage with mental health services.

Conclusions: Emergency clinicians have an opportunity to ensure subsequent linkage to mental health services for males post-crisis, with the aim of prevention of suicides.

Borderline personality disorder (BPD) is a highly stigmatised mental disorder. A variety of research exists highlighting the stigma experienced by individuals with BPD and the impacts of such prejudices on their lives. Similarly, much research exists on the benefits of engaging in compassionate acts, including improved mental health recovery. However, there is a notable gap in understanding how stigma experienced by people with BPD acts as a barrier to compassion and by extension recovery. This paper synthesises these perspectives, examining common barriers to compassionate acts, the impact of stigma on people with BPD, and how these barriers are exacerbated for individuals with BPD due to the stigma they face. The synthesis of perspectives in the article highlights the critical role of compassion in supporting the recovery of individuals with BPD, while also revealing the significant barriers posed by stigma. Addressing these challenges requires a comprehensive understanding of the intersection between compassion and stigma, informing the development of targeted interventions to promote well-being and recovery for individuals with BPD.

Variation exists in our attitude and behaviour towards food and exercise, resulting in different degrees of health and ill health. Cultural and economic factors contribute to this, alongside personal choices, leading to a spectrum from normative eating, through disordered eating to the extremes of eating disorders (EDs). Understanding the intricate interplay between biological, psychological, and sociocultural factors to eating, exercise and body image is paramount to understand the current state regarding EDs and to deliver/develop multifaceted and individualised treatments. Significant service developments have occurred following the launch of the Irish Health Service Executive Model of Care for EDs in 2018. However, incomplete roll out and surge in EDs referrals post Covid-19 require generic child and adolescent mental health services (CAMHS) to be competent in assessment of EDs, and to keep abreast of clinical updates in order to offer effective treatment.This review provides an evidenced based update on eating related difficulties, outlines a useful assessment framework, offers information on appropriate clinical management, and highlights exciting clinically relevant research developments.

Background: Cannabis is the most commonly used illicit substance in Ireland and globally. It is most likely to be used in adolescence, a period of biopsychosocial vulnerability to maladaptive behaviours. This study aims to investigate the risk and protective factors for cannabis use among adolescents.

Methods: This study is a secondary analysis of the cross-sectional Planet Youth survey (2021). The sample comprised 4,404 adolescents aged 15-16 from one urban and two rural areas in Ireland. The outcome of interest was current cannabis use, defined as cannabis use within the last 30 days. Independent variables i.e., risk and protective factors, were selected a priori following a literature review. Associations between cannabis use and the independent variables were explored using mixed-effects logistic regressions.

Results: The prevalence of current cannabis use was 7.3% and did not differ significantly between males and females. In fully-adjusted models, significant risk factors for cannabis use were: Having peers that used cannabis (Adjusted Odds Ration (aOR) 10.17, 95% CI: 5.96-17.35); Parental ambivalence towards cannabis use (aOR 3.69, 95% CI: 2.41-5.66); Perception of cannabis as non-harmful (aOR 2.32,95% CI 1.56-£.45): Other substance use (aORs ranging from 2-67-3.15); Peer pressure to use cannabis (aOR 1.85,95% CI 1.05-3.26), and Low parental supervision (aOR 1.11, 95% CI: 1.01-1.22).

Conclusions: This study identified key individual, peer-to-peer and parental risk factors associated with adolescent cannabis use, several of which have the potential to be modified through drug prevention strategies.