• Childhood trauma and cognitive function in first-episode affective and non-affective psychosis.

      Aas, Monica; Dazzan, Paola; Fisher, Helen L; Morgan, Craig; Morgan, Kevin; Reichenberg, Abraham; Zanelli, Jolanta; Fearon, Paul; Jones, Peter B; Murray, Robin M; et al. (2011-06)
      A history of childhood trauma is reportedly more prevalent in people suffering from psychosis than in the general population. Childhood trauma has also been linked to cognitive abnormalities in adulthood, and cognitive abnormalities, in turn, are one of the key clinical features of psychosis. Therefore, this study investigated whether there was a relationship between childhood trauma and cognitive function in patients with first-episode psychosis. The potential impact of diagnosis (schizophrenia or affective psychosis) and gender on this association was also examined.
    • Long-term maternal recall of obstetric complications in schizophrenia research.

      Walshe, Muriel; McDonald, Colm; Boydell, Jane; Zhao, Jing Hua; Kravariti, Eugenia; Touloupoulou, Timothea; Fearon, Paul; Bramon, Elvira; Murray, Robin M; Allin, Matthew; et al. (2011-05-30)
      Obstetric complications (OCs) are consistently implicated in the aetiology of schizophrenia. Information about OCs is often gathered retrospectively, from maternal interview. It has been suggested that mothers of people with schizophrenia may not be accurate in their recollection of obstetric events. We assessed the validity of long term maternal recall by comparing maternal ratings of OCs with those obtained from medical records in a sample of mothers of offspring affected and unaffected with psychotic illness. Obstetric records were retrieved for 30 subjects affected with psychosis and 40 of their unaffected relatives. The Lewis-Murray scale of OCs was completed by maternal interview for each subject blind to the obstetric records. There was substantial agreement between maternal recall and birth records for the summary score of "definite" OCs, birth weight, and most of the individual items rated, with the exception of antepartum haemorrhage. There were no significant differences in the validity of recall or in errors of commission by mothers for affected and unaffected offspring. These findings indicate that several complications of pregnancy and delivery are accurately recalled by mother's decades after they occurred. Furthermore, there is no indication that mothers are less accurate in recalling OCs for their affected offspring than their unaffected offspring. When comparing women with and without recall errors, we found those with recall errors to have significantly worse verbal memory than women without such errors. Assessing the cognition of participants in retrospective studies may allow future studies to increase the reliability of their data.
    • An update on the management of bipolar disorder

      Thekiso, T; Fearon, P (2011-05-19)
    • Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding.

      Wassif, Wassif S; McLoughlin, Declan M; Vincent, Royce P; Conroy, Simon; Russell, Gerald F M; Taylor, Norman F; Department of Clinical Biochemistry, King's College Hospital National Health Service Foundation Trust, London, United Kingdom. ws.wassif@bedfordhospital.nhs.uk (2011-05)
      To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.
    • Initial diagnosis and treatment in first-episode psychosis: can an operationalized diagnostic classification system enhance treating clinicians' diagnosis and the treatment chosen?

      Coentre, Ricardo; Blanco, Pablo; Fontes, Silvina; Power, Paddy; Lambeth Early Onset Service, SouthLondon and Maudsley NHS Trust, London, UK. ricardo.coentre@netc.pt (2011-05)
      Diagnosis during the initial stages of first-episode psychosis is particularly challenging but crucial in deciding on treatment. This is compounded by important differences in the two major classification systems, International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). We aimed to compare the concordance between an operationalized diagnosis using Operational Criteria Checklist (OPCRIT) and treating clinician-generated diagnosis in first episode psychosis diagnosis and its correlation with treatment prescribed.
    • Length of stay of general psychiatric inpatients in the United States: systematic review.

      Tulloch, Alex D; Fearon, Paul; David, Anthony S; Department of Psychiatry, Institute of Psychiatry, Kings College London, De Crespigny Park, London, SE5 8AF, UK, alexander.d.tulloch@kcl.ac.uk. (2011-05)
      Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.
    • Predictive factors for relapse after an integrated inpatient treatment programme for unipolar depressed and bipolar alcoholics.

      Farren, Conor K; McElroy, Sharon; Department of Psychiatry, St. Patrick’s Hospital and Trinity College Dublin, James Street, Dublin 8, Ireland. cfarren@stpatsmail.com (2011-04-27)
      The aim of this study was to examine prospectively examined predictors of relapse in alcohol dependence with comorbid affective disorder.
    • Extra information about treatment is too much for the patient with psychosis.

      Kennedy, Miriam; Dornan, Julieanne; Rutledge, Emer; O'Neill, Helen; Kennedy, Harry G; Central Mental Hospital, Dublin, Ireland. (2011-04-27)
      Case law across jurisdictions requires ever more complete disclosure of material facts when obtaining consent to treatment.
    • The role of ethnicity in clinical psychopathology and care pathways of adults with intellectual disabilities.

      Tsakanikos, Elias; McCarthy, Jane; Kravariti, Eugenia; Fearon, Paul; Bouras, Nick; Estia Centre, Institute of Psychiatry, King's College London, 66 Snowsfields, London SE1 3SS, UK. elias.tsakanikos@kcl.ac.uk (2011-04-27)
      The objective of this study was to explore whether people with intellectual disability from ethnic minority groups have higher rates of mental health problems and access different care pathways than their White counterparts. Clinical and socio-demographic data were collected for 806 consecutive new referrals to a specialist mental health service for people with intellectual disabilities in South London. Referrals were grouped according to their ethnic origin. The analyses showed that there was an over-representation of referrals from ethnic minority groups with diagnoses of schizophrenia spectrum disorder. In addition, Black participants were more likely to have an autistic spectrum disorder. Referrals of ethnic minority groups were considerably younger than White referrals, and less likely to be in supported residences. The results are discussed in the context of cultural and familial factors in particular ethnic groups that may play an important role in accessing and using mental health services.
    • Electroconvulsive therapy and nursing care.

      Kavanagh, Adam; McLoughlin, Declan M; Department of Psychiatry and Trinity College Institute of Neuroscience, Trinity College Dublin, St Patrick's University Hospital, Dublin, Ireland. (2011-04-27)
      Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.
    • Regional variation in electroconvulsive therapy use

      Dunne, R; McLoughlin, DM (Irish Medical Journal, 2011-03)
    • Regional variation in electroconvulsive therapy use.

      Dunne, R; McLoughlin, D M; Department of Psychiatry, Trinity College, St. Patrick's University Hospital, Dublin. ross.dunne@tcd.ie (2011-03)
      Although electroconvulsive therapy (ECT) is the most powerful treatment for depression, substantial variability in use has been described in Ireland. The Mental Health Commission collects usage data from approved centres but does not include home addresses or independent sector patients. Therefore, estimates of regional variation cannot be accurate, e.g. 145 (35% of total) independent sector patients were omitted from their 2008 analysis. When public and independent sector patients are combined inter-regional variation for 2008 is more than halved (chi-squared decreased from 83 to 30), with Western region contributing most to variation (chi-squared = 43). Ratio of ECT programmes to depressed admissions correlated negatively with rate for depressed admissions (r = -0.53, p = 0.01), while depressed admission numbers correlated with acute beds per area (r = 0.68, p = 0.001). Regional variation in ECT is less than previously reported; service factors probably account for much of this with smaller centres admitting severely ill patients more likely to require ECT.
    • Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis.

      Hodgins, Sheilagh; Calem, Maria; Shimel, Rhiannon; Williams, Andrew; Harleston, Dionne; Morgan, Craig; Dazzan, Paola; Fearon, Paul; Morgan, Kevin; Lappin, Julia; et al. (2011-02)
      Persons with severe mental illness (SMI) are at increased risk of criminal offending, particularly violent offending, as compared with the general population. Most offenders with SMI acquire convictions prior to contact with mental health services. This study examined offending among 301 individuals experiencing their first episode of psychosis.
    • Overcoming alcohol abuse: a 28 day guide

      Farren, C; St. Patrick's University Hospital, Dublin (Blackhall Press, 2011-02)
    • Mobile phone text message interventions in psychiatry - what are the possibilities?

      I.O. Agyapong, Vincent; K. Farren, Conor; M. McLoughlin, Declan (2011-02)
    • Shared care between specialized psychiatric services and primary care: the experiences and expectations of consultant psychiatrists in Ireland.

      Agyapong, Vincent I O; Conway, Catherine; Guerandel, Allys; University of Dublin Trinity College and St. Patrick's University Hospital, Dublin, Ireland. israelhans@hotmail.com (2011)
      Internationally, there has been a growing interest in the pursuit of collaborative forms of care for patients with enduring mental health difficulties.
    • The economic cost of pathways to care in first episode psychosis.

      Heslin, Margaret; McCrone, Paul; Flach, Clare; Fearon, Paul; Morgan, Kevin; Jones, Peter; Murray, Robin M; Dazzan, Paola; Doody, Gill; Morgan, Craig; et al. (2011)
      Few studies have examined the economic cost of psychoses other than schizophrenia and there have been no studies of the economic cost of pathways to care in patients with their first episode of psychosis. The aims of this study were to explore the economic cost of pathways to care in patients with a first episode of psychosis and to examine variation in costs. Data on pathways to care for first episode psychosis patients referred to specialist mental health services in south-east London and Nottingham between 1997-2000. Costs of pathway events were estimated and compared between diagnostic groups. The average costs for patients in south-east London were £54 (CI £33-£75) higher, compared to patients in Nottingham. Across both centres unemployed patients had £25 (CI £7-£43) higher average costs compared to employed patients. Higher costs were associated with being unemployed and living in south-east London and these differences could not be accounted for by any single factor. This should be considered when the National Health Service (NHS) is making decisions about funding.
    • Residential mobility among patients admitted to acute psychiatric wards

      Tulloch, Alex D.; Fearon, Paul; David, Anthony S. (2011)
    • Early interventions for people with psychotic disorders

      Power, P; McGorry, PD; St. Patrick's University Hospital, Dublin (Oxford University Press, 2011)