IRISH JOURNAL OF PSYCHOLOGICAL MEDICINE最新文献

Crisis Resolution Teams (CRTs) are being piloted in Ireland as community-based, intensive, short-term services providing rapid intervention for individuals experiencing acute mental health crises. This perspective highlights a group over-represented in emergency care pathways: autistic adults without intellectual disability. For many autistic adults, crises can emerge from burnout, transition pressures and sensory or communication overload, often presenting with heightened distress or suicidality. In systems with limited onward pathways, brief-episode crisis care can become part of a cycle of repeated contacts, with limited scope to address enduring neurodevelopmental needs. We outline pragmatic adaptations: autism-informed workforce education; proactive crisis and safety planning; clear crisis service boundaries with connected pathways for ongoing support; and cross-sector coordination across health and social services. Embedding lived-experience and data capture in learning-sites can drive improvement. Aligned with the Crisis Resolution Service Model of Care and autism policy, these steps can improve safety, equity and continuity of care.

Objectives: Screening tools for attention-deficit/hyperactivity disorder (ADHD) help to identify individuals likely to have ADHD. Several screening scales are used for identifying adults with ADHD, based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ADHD symptoms described in the DSM were originally developed to describe the behaviours of children, not adults, and focus on the triad of symptoms of inattention, hyperactivity, and impulsivity. Clinical research and experience, however, have revealed additional dimensions of adult ADHD, such as hyperfocus, racing thoughts, emotional lability, impaired sleep, and differences in time perception. Commensurate with the conditions' growing recognition, the adult ADHD presentation requires rethinking.

Methods: To understand better the ADHD symptomatology experienced by adults, qualitative interviews were conducted with 11 diagnosed adults.

Results: Using thematic analysis, nine themes of adult ADHD symptoms were identified. The first three themes map to the original triad of symptoms - attentional difficulties, hyperactivity, and impulsivity. A further three themes identified are briefly mentioned in the DSM - disorganisation, forgetfulness, and reduced activation. The final three themes are covered to some degree in the current rating scales but are absent from the DSM 5 - emotional lability, sleep difficulties, and time perception difficulties.

Conclusions: This study highlights nine themes relevant to adult ADHD, six of which are absent from the DSM 5's triad. This research highlights gaps in current assessment tools and suggests symptoms that are more reflective of the adult experience of having ADHD.

A self-binding directive (SBD) can be included in mental health advance decision documents to request future involuntary treatment. SBDs are supported by service users but controversial and empirical evidence on their application is scarce. Here we present a first case report which describes the experience of a service user with bipolar disorder (hereafter 'bipolar') who has chosen to use an SBD. We compare the findings of the case report with results from a systematic review of reasons for and against SBDs. We discuss that the experience of the service user supports SBDs as a tool to maximise autonomy and challenge criticisms around negative liberty, implementation, capacity assessment, and harms. We conclude that this case report adds to mounting evidence that SBDs are a feasible, ethically justifiable intervention, supported by service users. Policy makers should consider supporting SBD implementation strategies within crisis care.

Over the past century, psychiatrists have neglected the importance of diet in the management of mental illness. This is especially the case in relation to mood disorders. There is now overwhelming evidence to support the view that a Mediterranean diet can play a role in the management of mood disorders. This is not in any way denying the importance of pharmacological and psychosocial strategies in the management of these disorders. Components of the Mediterranean diet not only impact brain function but also gut microbes, which are increasingly recognised as playing a role in the pathophysiology of mood disorders. Nutrition should be a component in the curriculum of psychiatrists in training.

Anorexia nervosa (AN) is a complex psychiatric illness with severe and life-threatening medical sequelae, including death. Existing evidence-based treatments are linked to good prognosis and full recovery in many. For a small minority of critically ill patients, treatment decisions extend beyond voluntary engagement. Severe cases may involve involuntary hospitalisation, nasogastric feeding, physical restraint, and other coercive measures. While these interventions are sometimes necessary to prevent death, they raise profound ethical concerns. This article explores the ethical tensions in treatment of individuals with AN through the lens of the four principles of biomedical ethics, respect for autonomy, beneficence, non-maleficence, and justice, examining the implications for clinical practice. It also outlines the legal mechanisms in Ireland governing involuntary treatment for AN. It considers treatment principles in children and adolescents as well as adults.

Objectives: Understanding service users' knowledge of and attitudes towards the rapidly progressing field of mental health technology (MHT) is an important endeavour in clinical psychiatry.

Methods: To evaluate the current use of and attitudes towards MHT (mobile apps, online therapy and counselling, telehealth, web-based programmes, chatbots, social media), a 5-point Likert-scale survey was designed based on previous studies and distributed to attendees of an adult community mental health service in Ireland. Chi-square tests were used and corrected for multiple comparisons.

Results: 107 mental health service users completed the survey (58% female, aged 18-80). 86% of respondents owned a smartphone. 27.1% reported using a mental health application, while 33.6% expressed interest in using one in the future. 61.7% reported they had not used and were not interested in using AI for their mental health, and 51.4% indicated they would not feel comfortable using it. 46.8% were not comfortable with psychiatrists utilising AI in their care. The majority (86.9%) preferred face-to-face appointments, while 52.6% would consider using MHT while on a waiting list. Younger participants reported significantly greater comfort using mental health apps and higher self-rated knowledge of AI.

Conclusion: There were low levels of knowledge about and comfort using MHT, accompanied by concerns about confidentiality and privacy. Younger service users tended to be more comfortable with and knowledgeable about MHT. Despite the growing interest in digital approaches, there remains a clear preference for face-to-face appointments, underscoring the importance of addressing privacy and safety concerns, together with training and education.

Rising concerns about poor adolescent mental health have often focused on girls and self-harm, yet growing evidence highlights the negative impact on boys-particularly those who feel alienated and turn to online spaces for socialization. This carries the risk of exposure to extremist content, as seen in toxic subcultures like the incel movement, and dramatized in the recent Netflix series Adolescence (2025). Declining face-to-face socialization and weakened parental support further compound vulnerabilities. Addressing this crisis requires multi-level interventions, including digital literacy education, stronger online safety regulations, and community-based mental health support. Urgent policy action and further research are needed to mitigate the harmful effects of online radicalization on youth.

Background: This study evaluated the efficacy and acceptability of Ireland's National Clinical Programme for ADHD in Adults (NCPAA), providing public assessment and supports for adults with ADHD.

Methods: Overall, 249 adults (51% women, 42% men, 4% non-binary, 1% other gender) were recruited from three NCPAA services using consecutive sampling. Participants completed the Adult Self-Report Scale (ASRS) and the Weiss Functional Impairment Rating Scale (WFIRS-S) at baseline, 6, and 12 months; service satisfaction was measured with the Service Satisfaction Scale (SSS). Reflexive thematic analysis explored responses to two open-ended questions.

Results: Service users presented with high baseline symptomatology and life challenges. Significant improvements were observed in ASRS and WFIRS-S (except education) in the first six months. Improvements were retained at 12 months in ASRS and WFIRS-S domains of work, life skills, self-concept and social. but not family, risk or education. Service satisfaction was high, particularly among those diagnosed with ADHD. Thematic analysis identified three positive themes: feeling affirmed, benefits of supports, and person-centred care; and three improvement areas: access barriers, resource gaps, and need for ongoing support.

Conclusions: Engagement with NCPAA services is associated with improvements in ADHD symptoms and life challenges and is acceptable to adults with ADHD in the short term. Service limitations, particularly staffing constraints, warrant attention. Recommendations include strengthening resources, improving communication and appointment systems, and enhancing links to external supports. Given the absence of a control group, findings should be considered preliminary.