IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

Objectives: To characterise hospital-treated multimorbidity patterns in people who subsequently died a drug-related death in Scotland, and to identify clinically meaningful associations among conditions and decedent to inform prevention and care.

Methods: A register-based retrospective cohort study using nationally linked hospital admission (1996-2019) and mortality (2008-2019) records for 5,749 decedents. We identified hospital admissions for Elixhauser comorbidities using ICD-10 codes. Correlation analysis, network analysis, and Bayesian clustering were used to describe co-occurring conditions and identify patient clusters with distinct comorbidity profiles.

Results: Over half (50.9%) of decedents had at least one admission for an Elixhauser comorbidity. The most frequent were related to alcohol use (38.2%), drug use (29.1%), other neurological disorders (18.0%, mainly epilepsy/seizures/anoxic brain injury), depression (15.2%), and psychoses (12.5%). Network analysis highlighted drug use, alcohol use, psychoses, depression, and neurological disorders as central conditions. Bayesian clustering identified seven distinct patient clusters, including groups characterised by: high psychiatric and drug-use admissions; extensive physical comorbidities; alcohol and liver disease; dominant neurological issues and depression.

Conclusions: Individuals experiencing drug-related deaths exhibit substantial multimorbidity with distinct patterns often dominated by substance use and mental ill-health but also including significant physical health clusters. These distinct profiles underscore the need for integrated, tailored care strategies addressing substance use, psychiatric, and physical health needs to mitigate mortality risk.

"Dual disorders" (DD) refers to the co-occurrence of addiction and other mental health conditions, which often interact and complicate care. Despite scientific evidence showing shared brain mechanisms, current diagnostic systems treat them separately, leading to fragmented treatment and stigma. The World Association on Dual Disorders urges adopting "dual disorders" as a unified term to improve clarity, care integration, and outcomes.

In this editorial we set out the background to the advent and development of the concept of recovery in mental health care. We follow this with an overview of policy with specific reference to our own locale here in Wales where a recovery-focus is now written into national mental health legislation and policy directions. We briefly summarise our own research in this area and note positive relationships between recovery and social support and quality of life but also limited shared understanding of what recovery might mean alongside gaps in policy aspirations and everyday experiences of using services. The concept of recovery remains contested with concerns it has become a means for neoliberal thinking in services and in effect has been colonised by competing ideas. Despite this (sometimes) conflicting evidence and the polyvalent quality of the concept, recovery retains a sense of vitality and validity as evidenced by contributions to this special issue of the journal. Building on our reading of this growing literature we suggest that recovery necessitates social change, implies an understanding of systems and awareness of complexity and finally must account for and accommodate competing understandings. To achieve its foundational aims, it is imperative that research in this field directly engages and includes people with experience of using mental health services as co-researchers in generating new recovery-focused interventions to address the challenges of severe mental illness experiences.

Objectives: To compare verbal memory encoding, storage, and retrieval in patients with schizophrenia (SZ), SZ plus substance use disorder (SZ+), and substance use disorder only (SUD), testing the hypothesis that SZ + group exhibits greater impairment across all processes.

Methods: A total of 294 male patients under treatment (SZ = 72, SZ+ = 72, SUD = 150) meeting DSM-5 criteria completed the Rey Auditory Verbal Learning Test (RAVLT). RAVLT measures assessed encoding, storage, and retrieval. ANCOVA/MANCOVA, controlling for premorbid IQ, were used to explore group differences.

Results: Significant differences among groups were observed in all RAVLT measures (F(2,291) > 9.25, p < 0.001, ηp² > 0.06) except retrieval. Post hoc analyses revealed that both SZ and SZ+ groups showed significant verbal memory impairments (learning trials and storage, interference, short and long-term recall and recognition) compared to the SUD group which performed within the normative range. The SZ and SZ+ groups showed altered values (Z ≥ -1.5) from the second learning trial onward and total learning, and the SZ+ group also for long-term recall and recognition.

Conclusions: This study confirms the existence of significant verbal memory deficits in both SZ and SZ+ groups compared to SUD. Verbal memory impairment appears as a central feature of SZ spectrum disorders, irrespective of SUD comorbidity. Exacerbated memory impairment in SZ+ compared to SZ on the RAVLT is subtle without reaching significant differences, although consideration of altered Z-scores suggests worse performance in SZ+ in encoding and consolidation processes. Further research should explore clinical variables and moderators of comorbidity effects in SZ.

This article addresses the questions of when mental health advance planning documents are created, the points when circumstances which they are intended to address arise and what consequences should flow when such a situation does arise. It addresses these points primarily from the perspective of what the law could/should be at a conceptual level. It looks at three stages: (a) creation of the document; (b) the period between the creation of the document and the point at which the intended circumstances arise; and (c) the point at which the intended circumstances arise. It does not purport to provide solutions at each stage, but rather to frame the dilemmas to aid discussion. In similar vein, it draws upon case studies from England & Wales, not to purport to dictate similarities of approach, but to flesh out dilemmas that have arisen to stimulate consideration.

Gaming disorder (GD) is increasingly recognized as a clinically significant condition, yet its implications in first-episode psychosis (FEP) remain largely unexplored. This perspective article focuses on the intersection of GD and FEP, highlighting key diagnostic and treatment challenges, including symptom overlap that complicates differential diagnosis, the absence of validated screening tools, and difficulties in sustained patient engagement. Drawing insights from substance use disorder management in FEP, we propose a preliminary clinical framework for integrating GD assessment and intervention into early intervention in psychosis programs. This approach prioritizes comprehensive evaluation, patient-centered care, and a harm-reduction model that supports digital well-being. Addressing GD inFEP populations is crucial for optimizing functional recovery and promoting a holistic, recovery-oriented approach to psychiatric care. Further research is needed to refine screening tools and validate tailored interventions in this population.

The burden of cancer worldwide is rising, with 20 million new cases diagnosed in 2022. In Europe, 1.2 million women are diagnosed with cancer annually and an estimated 600,000 women die from cancer each year. International research and data from Ireland demonstrate that women with cancer face a particular set of challenges, including increased psychological distress compared to men. As a result, Ireland's Model of Care for Psycho-Oncology could usefully place greater emphasis on gender-specific provisions which address the increased psychological needs of women. To date, Ireland has made some progress in recognising the physical and mental healthcare needs of women and developing gender-informed policies. It is essential that such policies are implemented fully so as to reduce and eliminate disparities in care. A more tailored, gender-informed approach would also help ensure the provision of gender-aware psycho-oncological care for all women and men as they navigate their cancer journeys.

The co-occurrence of mental illness and substance use disorders (SUDs) presents a significant public health challenge with affected individuals facing compounded stigma that leads to poor health outcomes, social exclusion, and systemic neglect. Despite growing recognition of stigma as a social determinant of health in people with comorbid mental illness and SUDs, current responses remain largely confined to clinical and academic settings. This article argues that civil society, particularly groups led by individuals with lived experience, represents an underutilized yet powerful force in combating stigma. Drawing from historical movements such as HIV/AIDS activism and contemporary examples from peer-led movements, we highlight how civil society organizations (CSOs) have reshaped public discourse, influenced policy, and fostered inclusive research. We examine emerging efforts in low resource settings and explore the transformative potential of digital civil society spaces. We advocate for a shift in stigma reduction paradigms to those that center lived experience, supports cross-sectoral collaboration, and recognizes both physical and digital civil society as essential to inclusive and sustainable change. To addressing the complex and intersecting stigmas associated with comorbid mental illness and SUDs, we recommend investing in CSOs, especially those grounded in participatory, culturally relevant approaches, particularly in low- and middle-income settings.