ORCID Profile
0000-0003-0686-8313
Current Organisation
Royal College of Surgeons in Ireland
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Publisher: Royal College of Psychiatrists
Date: 15-03-2023
DOI: 10.1192/BJP.2023.21
Abstract: Currently there is no first-line treatment recommended for the negative symptoms of schizophrenia. Psychosocial and behavioural interventions are widely used to reduce the burden of negative symptoms. Meta-analytic studies have summarised the evidence for specific approaches but not compared evidence quality and benefit. To review and evaluate the evidence from meta-analytic studies of psychosocial and behavioural interventions for the negative symptoms of schizophrenia. A systematic literature search was undertaken to identify all meta-analyses evaluating psychosocial and behavioural interventions reporting on negative symptom outcomes in people with schizophrenia. Data on intervention, study characteristics, acceptability and outcome were extracted. Risk of bias was evaluated. Results were summarised descriptively, and evidence ranked on methodological quality. In total, 31 systematic reviews met the inclusion criteria evaluating the efficacy of negative symptom interventions on 33 141 participants. Exercise interventions showed effect sizes (reduction in negative symptoms) ranging from −0.59 to −0.24 and psychological interventions ranging from −0.65 to −0.04. Attrition ranged between 12% to 32%. Across the studies considered heterogeneity varied substantially (range 0–100). Most of the reviews were of very low to low methodological quality. Methodological quality ranking suggested that the effect size for cognitive remediation and exercise therapy may be more robust compared with other approaches. Most of the interventions considered had a small-to-moderate effect size, good acceptability levels but very few had negative symptoms as the primary intervention target. To improve the confidence of these effect sizes being replicated in clinical settings future studies should minimise risk of bias.
Publisher: Springer Science and Business Media LLC
Date: 11-08-2010
DOI: 10.1007/S00127-009-0104-7
Abstract: Involuntary admission legislation and rates differ greatly throughout the European Union Member States. In Ireland, the Mental Health Act 2001 has introduced significant changes in the care for patients admitted involuntarily, including mental health tribunals that review the involuntary admission orders. To investigate (1) people's perception of the involuntary admission, (2) awareness of legal rights and perception of tribunal, (3) the impact of being admitted involuntarily on the relationship with their family, consultant psychiatrist and prospects for future employment. Over a 15-month period patients admitted involuntarily to a Dublin Hospital were interviewed using a semi structured interview. Eighty-one people participated in the study. Seventy-two percent of patients believed that their involuntary admission was necessary at the time and this was associated with greater insight into illness. A total of 77.8% of patients felt that the treatment they received had been beneficial. A total of 86.4% of patients were aware that they had been admitted involuntarily and 45.5% of patients found it easier to accept that they had been admitted involuntarily as their case was reviewed by a tribunal. A total of 27.5% experienced a negative impact upon the relationship with their family as a result of the involuntary admission, while for 15% there was a positive impact. For 26.6% of patients the doctor-patient relationship was negatively impacted upon and a third felt their prospects for employment could be affected. The majority of patients reflect positively on their involuntary admission and this opportunity should be used to engage patients in follow-up treatment.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.SCHRES.2014.05.022
Abstract: Psychotic disorders are associated with a significant impairment in occupational functioning that can begin in the prodromal phase of the disorder. As a result, in iduals with a psychotic disorder may not maintain their social class at birth. The aim of this study was to examine the distribution of the social classes of in iduals presenting with a first episode of psychosis (FEP) compared to the general population and to their family of origin. We evaluated whether social drift was associated with depression, hopelessness and suicidality at first presentation. All in iduals with a FEP presenting to a community mental health service between 1995 and 1999 and to an early intervention service between 2005 and 2011were included. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses and clinical evaluations included the Calgary Depression Scale for Schizophrenia, Beck Hopelessness Scale and the Suicidal Intent Scale. 330 in iduals were included in the study and by the time of presentation, in iduals with a FEP were more likely to be represented in the lower social classes compared to the general population. 43% experienced a social drift and this was associated with a diagnosis of a non-affective disorder, co-morbid cannabis abuse and a longer DUP. In iduals who did not experience a social drift had a higher risk of hopelessness. Social drift is common in psychotic disorders however, in iduals who either maintain their social class or experience upward social class mobility are more susceptible to hopelessness.
Publisher: American Psychiatric Association Publishing
Date: 05-2013
DOI: 10.1176/APPI.PS.001912012
Abstract: OBJECTIVE Service users may express positive, ambivalent, or negative views of their hospital admission. The objective of this study was to determine whether the background of the interviewer-service user-researcher or clinician-influences the information elicited. The primary outcome was the level of perceived coercion on admission, and secondary outcomes were perceived pressures on admission, procedural justice, perceived necessity for admission, satisfaction with services, and willingness to consent to participate in the study. METHODS Participants voluntarily and involuntarily admitted to three hospitals in Ireland were randomly allocated to be interviewed at hospital discharge by either a service user-researcher or a clinician. Interviewers used the MacArthur Admission Experience Survey and the Client Satisfaction Questionnaire. RESULTS A total of 161 participants were interviewed. No differences by interviewer status or by admission status (involuntary or voluntary) were found in levels of perceived coercion, perceived pressures, procedural justice, perceived necessity, or satisfaction with services. Service users were more likely to decline to participate if their consent was sought by a service user-researcher (24% versus 8%, p=.003). CONCLUSIONS Most interviewees gave positive accounts of their admission regardless of interviewer status. The findings indicate that clinicians and researchers can be more confident that service users' positive accounts of admissions are not attributable to a response bias. Researchers can also feel more confident in directly comparing the results of studies undertaken by clinicians and by service user-researchers.
Publisher: Wiley
Date: 05-03-2020
DOI: 10.1111/EIP.12937
Publisher: Cambridge University Press (CUP)
Date: 09-2010
DOI: 10.1017/S0790966700001282
Abstract: Focused management strategies, including effective distribution of available resources is dependent on ongoing analysis of referral type in any liaison psychiatry consultation service. This survey sought to measure rate of diagnoses in an Irish liaison psychiatry consultation service, and compare the results with other similar services. A survey of referral reasons and diagnoses was performed on all patients presenting to a Dublin based inpatient liaison psychiatry consultation service over two six month periods. The results were subsequently compared with other similar international studies. Commonest referral reasons were for depressive disorders, while commonest diagnoses included alcohol related disorders, depressive disorders, and delirium, with notably higher rates of alcohol related disorders than in other similar international studies. This study provides valuable information for referral reasons and diagnoses present in an Irish liaison psychiatry consultation service. The differences noted between diagnoses in our study and other international studies, as well as some of the difficulties in establishing these diagnoses, are discussed.
Publisher: Springer Science and Business Media LLC
Date: 27-10-2012
DOI: 10.1007/S11845-010-0511-5
Abstract: Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting. To measure the length of time from referral to consultation in a liaison psychiatry service, and improve service delivery by introducing guidelines for time to consultation. Time to consultation was measured on all patients presenting to a liaison psychiatry consultation service over an initial 6-month period, with subsequent repeat measurement following the introduction of guidelines. There were significant reductions for time to consultation in the service for the second cycle of the audit (χ(2) = 43.84, P < 0.001), and targets based on international standards were achieved. Introduction of guidelines for time to consultation, may improve response times, leading to improved quality of service for inpatient consultation services.
Publisher: Cambridge University Press (CUP)
Date: 05-2011
DOI: 10.1016/J.EURPSY.2010.01.014
Abstract: We sought to determine the level of procedural justice experienced by in iduals at the time of involuntary admission and whether this influenced future engagement with the mental health services. Over a 15-month period, in iduals admitted involuntarily were interviewed prior to discharge and at one-year follow-up. Eighty-one people participated in the study and 81% were interviewed at one-year follow-up. At the time of involuntary admission, over half of in iduals experienced at least one form of physical coercion and it was found that the level of procedural justice experienced was unrelated to the use of physical coercive measures. A total of 20% of participants intended not to voluntarily engage with the mental health services upon discharge and they were more likely to have experienced lower levels of procedural justice at the time of admission. At one year following discharge, 65% of participants were adherent with outpatient appointments and 18% had been readmitted involuntarily. Insight was associated with future engagement with the mental health services however, the level of procedural justice experienced at admission did not influence engagement. This study demonstrates that the use of physical coercive measures is a separate entity from procedural justice and perceived pressures.
Publisher: Wiley
Date: 14-07-2017
DOI: 10.1111/EIP.12255
Abstract: Quality of life (QOL) in first-episode psychosis (FEP) is impaired when compared to non-clinical controls and several clinical factors including symptoms and untreated psychosis have been linked with poorer QOL. Measurement methods are varied, however, resulting in inconsistent findings and there is a need to simultaneously combine subjective and objective measures of QOL. We examined both subjective (n = 128) and objective QOL (n = 178) in a catchment area cohort of in iduals with FEP (n = 222) to determine correspondence between patient satisfaction and clinician-rated functional domains. We also examined the contribution of sociodemographic and clinical characteristics to both subjective and objective QOL. There were complex relationships between subjective and objective QOL domains in that patient's assessments of health status (psychological well-being, symptoms/outlook, physical health) were not correlated with clinicians but there were strong correlations between social functioning domains (occupation, social relations, financial status and activities of daily living) assessed by patients and clinicians. Longer duration of untreated psychosis, being treated as an inpatient, higher positive symptoms and poorer social functioning in client-rated QOL domains predicted poorer objective QOL. We found that both subjective and objective assessments of QOL displayed a degree of clinical utility demonstrated by relationships between clinical factors and both QOL perspectives. Moreover, the lack of association between patient characteristics and QOL shows some potential malleability of QOL outcomes through intervention as there were several clinical factors linked with both subjective and objective QOL.
Publisher: Cambridge University Press (CUP)
Date: 03-2014
DOI: 10.1016/J.EURPSY.2013.02.003
Abstract: Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear. We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment. Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 in iduals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding. PONS prevalence was 50.3% in the schizophrenia spectrum group ( n = 155) and 31.2% in the non-schizophrenia spectrum group ( n = 218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ 2 = 10.41, P 0.001) and adjusted (OR = 2.40, 95% CI = 1.11–5.22, P = 0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group. PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.SCHRES.2012.01.004
Abstract: The relevance of negative symptoms across the diagnostic spectrum of the psychoses remains uncertain. The purpose of this study was to report on prevalence of item and subscale level negative symptoms across the first episode psychosis (FEP) diagnostic spectrum in an epidemiological s le, and to ascertain whether items and subscales were more prevalent in a schizophrenia spectrum diagnoses group compared to an 'all other psychotic diagnoses' group. We measured negative symptoms in 330 patients presenting with FEP using the Scale for Assessment of Negative Symptoms (SANS), and ascertained diagnosis using the Structured Clinical Interview for DSM IV. Prevalence of SANS items and subscales were tabulated across all psychotic diagnoses, and logistic regression analysis determined which items and subscales were predictive of schizophrenia spectrum diagnoses. SANS items were most prevalent in schizophrenia spectrum conditions but frequently presented in other FEP diagnoses, particularly substance induced psychotic disorder and Major Depressive Disorder. Brief psychotic disorder and bipolar disorders had low levels of negative symptoms. SANS items and subscales which significantly predicted schizophrenia spectrum diagnoses, were also frequently present in some of the other psychotic diagnoses. SANS items have high prevalence in FEP, and while commonest in schizophrenia spectrum conditions are not restricted to this diagnostic subgroup.
Publisher: Informa UK Limited
Date: 08-02-2011
DOI: 10.3109/10826081003754757
Abstract: A retrospective patient record review was conducted to examine comorbid psychiatric diagnoses, and comorbid substance use, among 465 patients below 45 years of age, presenting to a national alcohol addiction treatment unit in Dublin, between 1995 and 2006. Rates were high for depressive disorder (25.3%) particularly among females (35.4%). Lifetime reported use of substances other than alcohol was 39.2%, and further analysis showed significantly higher rates of deliberate self-harm among this group. Lifetime reported use of ecstasy was also significantly associated with depression in this alcohol-dependent population using logistic regression analysis. Implications and limitations of the findings are discussed.
Publisher: Springer Science and Business Media LLC
Date: 14-07-2010
DOI: 10.1007/S11845-009-0385-6
Abstract: National population surveys and information from the National Drug Treatment Reporting System indicate cocaine use is increasing. There is a paucity of studies focusing on comorbid cocaine and alcohol use in Ireland. The aims of the study are to examine comorbid cocaine and alcohol use patterns in those under 45 years, presenting to a national addiction treatment unit for alcohol and drug dependence. A retrospective review of the substance misuse behavior of 465 in iduals participating in an addiction rehabilitation programme for alcohol dependence. Cocaine use among this population rose significantly between 1995 (8%) and 2006 (37.9%). There was a significant association between lifetime reported cocaine use and both psychotic disorders and deliberate self harm. Overall, the use was highest among younger age group and this declined steadily with age. Cocaine use among the alcohol-dependent population is an increasing problem in the Republic of Ireland, and poses a problem of higher toxicity associated with concurrent cocaine and alcohol use.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Publisher: Wiley
Date: 27-10-2018
DOI: 10.1111/EIP.12501
Abstract: Negative symptoms are a cause of enduring disability in serious mental illness. In spite of this, the development of effective treatments for negative symptoms has remained slow. The challenge of improving negative symptom outcomes is compounded by our limited understanding of their aetiology and longitudinal development. A literature search was conducted for life course approach of negative symptoms using PubMed. Further articles were included following manual checking of reference lists and other search strategies. The paper contains a theoretical synthesis of the literature, summarized using conceptual models. Negative symptom definitions are compared and considered within a context of the life course. Previous studies suggest that several illness phases may contribute to negative symptoms, highlighting our uncertainty in relation to the origin of negative symptoms. Similar to other aspects of schizophrenia, negative symptoms likely involve a complex interplay of several risk and protective factors at different life phases. Concepts suggested in this article, such as "negative symptom reserve" theory, require further research, which may inform future prevention and treatment strategies.
Publisher: Cambridge University Press (CUP)
Date: 18-10-2017
DOI: 10.1017/IPM.2017.60
Abstract: The Mental Health Act 2001 has introduced significant changes to the process of admission to hospital for in iduals affected by mental health disorders. This study aimed to determine whether a newly designed smartphone application could result in an improvement in service users’ knowledge of their rights compared with the paper booklet. This was a randomized study conducted in an outpatient and day-hospital in North Dublin. Participants were randomized to receive the information booklet as either a smartphone application or in the paper form. A questionnaire which was scored from 0 to 10 was devised and was completed at baseline and at 1-week follow-up. A total of 42 in iduals completed the baseline and follow-up questionnaire and of these, 53.7% were female and the mean age was 38.2 years ( s.d. ±13.5). A total of 34.1% had a diagnosis of a psychotic disorder, 29.3% had a depressive disorder and 22% had bipolar-affective disorder. The mean score before the intervention in the total group was 3.5 ( s.d. ±2.2) and this increased to 5.8 ( s.d. ±2.2) at follow-up. Participants randomized to the smartphone application improving by a mean of 2.5 ( s.d. ±2.5), while those randomized to the booklet improving by a mean of 2.3 ( s.d. ±2.6), which was not statistically significant. Both forms of the information booklet showed improvement in service users’ knowledge of their legal rights. It is possible that each in idual will have preference for either a paper form or a smartphone form and this study suggests that both forms should be offered to each in idual service user.
Publisher: Cambridge University Press (CUP)
Date: 26-02-2023
DOI: 10.1017/IPM.2020.132
Abstract: When presenting with a first episode of psychosis (FEP), migrants can have different demographic and clinical characteristics to the native-born population and this was examined in an Irish Early Intervention for Psychosis service. All cases of treated FEP from three local mental health services within a defined catchment area were included. Psychotic disorder diagnoses were determined using the SCID and symptom and functioning domains were measured using validated and reliable measures. From a cohort of 612 people, 21.1% were first-generation migrants and there was no difference in the demographic characteristics, diagnoses, symptoms or functioning between migrants and those born in the Republic of Ireland, except that migrants from Africa presented with less insight. Of those admitted, 48.6% of admissions for migrants were involuntary compared to 37.7% for the native-born population ( p = 0.09). First-generation migrants now make up a significant proportion of people presenting with a FEP to an Irish EI for psychosis service. Broadly the demographic and clinical characteristics of migrants and those born in the Republic of Ireland are similar, except for less insight in migrants from Africa and a trend for a higher proportion of involuntary admissions in the total migrant group.
Publisher: Cambridge University Press (CUP)
Date: 18-12-2015
DOI: 10.1017/IPM.2014.79
Abstract: Study of illness characteristics and symptoms in a young population with psychosis can assist for understanding of their needs, and can inform service planning strategies. The aims of the current study were to describe illness characteristics and symptoms of a first episode psychosis (FEP) s le aged 25 years and under, and compare with a s le aged over 25 years. Interviews were conducted for 437 in iduals aged 16–65 years presenting with suspected psychosis between 2005 and 2012 in a defined catchment area (population of 390 000) using the Structured Clinical Interview for DSM IV to determine the presence of a psychosis diagnosis. In iduals with confirmed psychosis were assessed using standardised instruments to determine illness characteristics at first presentation. Among the 25 years, and under FEP s le, 23.9% had their first onset of symptoms (prodromal or psychotic) before 18 years of age. After controlling for confounders, the s le aged 25 years and under had a significantly shorter log transformed duration of untreated psychosis ( p =0.002), more negative symptoms ( p =0.045) and greater frequency of comorbid cannabis abuse diagnosis ( p =0.027). Symptom onset in a youth FEP s le frequently occurs before age 18 years. Certain illness characteristics differed across the age categories, such as greater negative symptoms and cannabis abuse in the youth s le. Overall, the findings support the provision of adequate strategies for management of negative symptom deficits and substance abuse across all ages in FEP.
Publisher: SAGE Publications
Date: 19-04-2015
Abstract: In iduals with psychotic disorders are represented more in the lower social classes, yet there is conflicting evidence to whether these in iduals drift into the lower social classes or whether lower social class is a risk factor for developing psychosis. The aim of this study was to examine whether the social class at birth is a risk factor for developing psychosis. We included in iduals with a first episode of psychosis (FEP) whose social class at birth was determined from birth records. We employed a case-control study design and also compared the distribution of the social classes at birth of the cases to that of the general population. A total of 380 in iduals with an FEP and 760 controls were included in the case-control study. The odds ratio for developing an FEP associated with social class (low vs high) was .62 (95% confidence interval (CI): .46–.85, p .001), indicating that in iduals from a lower social class at birth have a reduced risk of psychosis. In iduals born between 1961 and 1980 with an FEP were more likely to be from a higher social class at birth compared to the general population (60.8% vs 36.7%, χ 2 = 60.85, df = 1, p .001). However, this association was not observed for those born between 1981 and 1990. A higher social class at birth is associated with a greater risk for developing a psychotic disorder however, this effect may show temporal variation.
Publisher: SAGE Publications
Date: 21-05-2023
DOI: 10.1177/00207640231174360
Abstract: Migration is a robust risk factor for developing a psychotic disorder, yet there is a paucity of research on the outcomes of migrants who develop a psychotic disorder. Identifying sub-groups within FEP cohorts who have a poorer outcome, could assist in the development and delivery of more targeted interventions. There is a paucity of research on the outcomes of migrants who develop a psychotic disorder. This study aimed to evaluate a broad range of outcomes for those with a FEP who migrated to the Republic of Ireland, including: (i) symptomatic (ii) functional (iii) hospitalisation and (iv) engagement with psychosocial services. All in iduals with a FEP aged 18 to 65 who presented between 01.02.2006 and 01.07.2014 were included. Structured and validated instruments were used to measure positive, negative, depressive symptoms and insight. Of the 573 in iduals with a FEP, 22.3% were first-generation migrants and 63.4% ( n = 363) were followed up at 1 year. At this time, 72.4% of migrants were in remission of positive psychotic symptoms compared to 78.5% of the Irish born ( OR = 0.84, 95% CI [0.50–1.41], p = .51). In relation to negative symptoms, 60.5% of migrants were in remission compared to 67.2% of the Irish born ( OR = 0.75, 95% CI [0.44–1.27], p = .283). There was no difference in the severity of positive, negative or depressive symptoms between groups and there was a trend for the Irish born to have better insight ( p = .056). The functional outcomes were similar across groups. One third of migrants were admitted to hospital compared to 28.7% of the Irish born ( OR = 1.24, 95% CI [0.73–2.13], p = .426). Just over half of both groups attended CBT and 46.2% of caregivers for migrants attended the psychoeducation programme, compared to 39.7% for the Irish born ( OR = 1.30, 95% CI [0.79–2.16], p = .306). These findings demonstrate that migrants have broadly similar outcomes to the native-born populations, however there is still considerable scope for the outcomes for all in iduals affected by psychotic disorders to be improved.
Publisher: Cambridge University Press (CUP)
Date: 25-05-2021
DOI: 10.1017/S003329172100177X
Abstract: Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. We included all presentations of first-episode psychosis over 8.5 years to the DETECT Early Intervention for psychosis service in the Republic of Ireland (573 in iduals aged 18–65, of whom 22% were first-generation migrants). Psychotic disorder diagnosis relied on SCID. The at-risk population was calculated using census data, and negative binomial regression was used to estimate incidence rate ratios. The annual crude incidence rate for a first-episode psychotic disorder in the total cohort was 25.62 per 100000 population at risk. Migrants from Africa had a nearly twofold increased risk for developing a psychotic disorder compared to those born in the Republic of Ireland (IRR = 1.83, 95% CI 1.11–3.02, p = 0.02). In contrast, migrants from certain Asian countries had a reduced risk, specifically those from China, India, Philippines, Pakistan, Malaysia, Bangladesh and Hong Kong (aIRR = 0.36, 95% CI 0.16–0.81, p = 0.01). Further research into the reasons for this inflated risk in specific migrant groups could produce insights into the aetiology of psychotic disorders. This information should also be used, alongside other data on environmental risk factors that can be determined from census data, to predict the incidence of psychotic disorders and thereby resource services appropriately.
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.PSYCHRES.2013.10.016
Abstract: The legal status of service users admitted to psychiatric wards is not synonymous with the level of coercion that they can perceive during the admission. This study aimed to identify and describe the proportion of in iduals who were admitted voluntarily but experienced levels of perceived coercion comparable to those admitted involuntarily. In iduals admitted voluntarily and involuntarily to three psychiatric hospitals were interviewed using the MacArthur Admission Experience Interview and the Structured Clinical Interview for DSM-IV diagnoses. One hundered sixty-one in iduals were interviewed and 22% of the voluntarily admitted service users had levels of perceived coercion similar to that of the majority of involuntarily admitted service users. Voluntarily admitted service users who experienced high levels of perceived coercion were more likely to have more severe psychotic symptoms, have experienced more negative pressures and less procedural justices on admission. In iduals brought to hospital under mental health legislation but who subsequently agreed to be admitted voluntarily and those treated on a secure ward also reported higher levels of perceived coercion. It needs to be ensured that if any service user, whether voluntary or involuntary, experiences treatment pressures or coercion that there is sufficient oversight of the practice, to ensure that in idual's rights are respected.
Publisher: Royal College of Psychiatrists
Date: 24-07-2019
DOI: 10.1192/BJP.2019.126
Abstract: Early intervention in psychosis is a complex intervention, usually delivered in a specialist stand-alone setting, which aims to improve outcomes for people with psychosis. Previous studies have been criticised because the control used did not accurately reflect actual practice. To evaluate the cost-effectiveness of early intervention by estimating the incremental net benefit (INB) of an early-intervention programme, delivered in a real-world setting. INB measures the difference in monetary terms between alternative interventions. Two contemporaneous incidence-based cohorts presenting with first-episode psychosis, aged 18–65 years, were compared. Costs and outcomes were measured over 1 year. The main outcome was avoidance of a relapse that required admission to hospital or home-based treatment. From the health sector perspective, the probability that early intervention was cost-effective was 0.77. The INB was €2465 per person (95% CI − €4418 to €9347) when society placed a value of €6000, the cost of an in-patient relapse, on preventing a relapse requiring admission or home care. Following adjustment, the probability that early intervention was cost-effective was 1, and the INB to the health sector was €3105 per person (95% CI −€8453 to €14 663). From a societal perspective, the adjusted probability that early intervention was cost-effective was 1, and the INB was €19 928 per person (95% CI − €2075 to €41 931). Early intervention has a modest INB from the health sector perspective and a large INB from the societal perspective. The perspective chosen is critical when presenting results of an economic evaluation of a complex intervention.
Publisher: Cambridge University Press (CUP)
Date: 05-02-2016
DOI: 10.1017/S003329171500286X
Abstract: The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood-level factors may influence this variation. It is also plausible that the duration of untreated psychosis (DUP) is associated with neighbourhood characteristics. The aims of this study were to determine whether the incidence of first-episode psychosis (FEP) and the DUP are associated with the level of social deprivation, fragmentation, social capital and population density. All in iduals with a FEP from a geographical defined catchment area over a 5-year period were included. Age-standardized incidence rates were calculated for each neighbourhood factor. A total of 292 cases of FEP were included in the study and 45% had a diagnosis of a schizophrenia-spectrum disorder. The age standardized incidence rate of FEP in the most deprived area was 72.4 [95% confidence interval (CI) 26.4–162.7] per 100 000 person-years compared with 21.5 (95% CI 17.6–26.0) per 100 000 person-years in the most affluent areas. This represents a 3.4-fold increase in FEP incidence in the most deprived areas. The incidence of FEP was also increased in neighbourhoods that were more socially fragmented [incidence rate ratio (IRR) = 2.40, 95% CI 1.05–5.51, p = 0.04] and there was a trend for the incidence to be increased in neighbourhoods with lower social capital (IRR = 1.43, 95% CI 0.99–2.06, p = 0.05). The median DUP was 4 months and was higher in more socially fragmented neighbourhoods. The incidence of psychotic disorders is related to neighbourhood factors and it may be useful to consider neighbourhood factors when allocating resources for early intervention services.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.IJNURSTU.2017.08.015
Abstract: Diminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks and perceived satisfaction, explore the clinical correlates of these outcomes and examine whether phases of untreated psychosis are linked with social network variables to determine potential opportunities for intervention. During the study period, we assessed 222 people with first-episode psychosis at entry into treatment using valid and reliable measures of diagnosis, positive and negative symptoms, periods of untreated psychosis and prodrome and premorbid adjustment. For follow-up we contacted participants to conduct a second assessment (n=158). There were 97 people who participated which represented 61% of those eligible. Social network and support information obtained at both time points included the number of friends, self-reported satisfaction with support and social network size and clinician's evaluation of the degree of support received through networks. Mixed effects modelling determined the contribution of potential explanatory variables to social support measured. A number of clinical variables were linked with social networks, support and perceived support and satisfaction. The size of networks did not change over time but those with no friends and duration of untreated psychosis was significantly longer for those with no friends at entry into treatment (n=129, Median=24.5mths, IQR=7.25-69.25 Mann-Whitney U=11.78, p=0.008). Social support at baseline and at one year was predicted by homelessness (t=-2.98, p=0.001, CI -4.74 to -1.21), duration of untreated psychosis (t=-0.86, p=0.031, CI -1.65 to -0.08) and premorbid adjustment (t=-2.26, p=0.017, CI -4.11 to -0.42). Social support improved over time but the duration of untreated psychosis was not linked with the rate of improvement in this outcome. Improved social support could indicate greater reliance on social support or becoming more adept at mobilising resources to meet social needs. Particularly vulnerable groups with very long duration of untreated psychosis confirm the need for earlier intervention or targeted social network interventions to preserve social connectedness.
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.JPSYCHIRES.2011.10.002
Abstract: Collaborative research projects have the potential to answer important research questions, which may otherwise require huge resources, funding, and time to complete. There are several scales for measuring psychotic symptoms in schizophrenia and other psychotic disorders, with the Scale for Assessment of Positive Symptoms (SAPS), Scale for Assessment of Negative Symptoms (SANS), Positive and Negative Symptom Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS) being among the most commonly used. High quality research efforts have used these three scales in different projects, and in order to merge study efforts, some means of combining data from these scales may be necessary. We reviewed correlations in published studies for these three scales, finding them to be highly correlated, however on comparison of the three scales there were considerable clinical differences between them. The paper discusses potential methods for combining the scales in collaborative research, including use of the recently developed standardised remission criteria for schizophrenia.
Publisher: Cambridge University Press (CUP)
Date: 06-2010
DOI: 10.1017/S0790966700001075
Abstract: Objectives : The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan. Methods : Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI). Results : Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan. Conclusions : With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.
Publisher: Cambridge University Press (CUP)
Date: 08-03-2017
DOI: 10.1017/IPM.2016.13
Abstract: The ‘Service Users’ Perspective of their Admission’ study examined voluntarily and involuntarily admitted services users’ perception of coercion during the admission process and whether this was associated with factors such as the therapeutic alliance, satisfaction with services, functioning and quality of life. This report aims to collate the findings of the study. The study was undertaken across three community mental health services in Ireland. Participants were interviewed before discharge and at 1 year using the MacArthur Admission Experience. Caregivers of participants were interviewed about their perception of coercion during the admission. A total of 161 service users were interviewed and of those admitted involuntarily, 42% experienced at least one form of physical coercion. Service users admitted involuntarily reported higher levels of perceived coercion and less procedural justice than those admitted voluntarily. A total of 22% of voluntarily admitted service users reported levels of perceived coercion comparable with involuntarily admitted service users and this was associated with treatment in a secure ward or being brought to hospital initially under mental health legislation. In comparison with the service user, caregivers tended to underestimate the level of perceived coercion. The level of procedural justice was moderately associated with the therapeutic relationship and satisfaction with services. After 1 year, 70% experienced an improvement in functioning and this was not associated with the accumulated level of coercive events, when controlled for confounders. This study has provided valuable insights into the perceptions of coercion and can help inform future interventional studies aimed at reducing coercion in mental health services.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.SCHRES.2015.07.004
Abstract: Factors that influence the age at onset in psychotic disorders could provide valuable insights into precipitating or causative factors of the disorder. Despite being established risk factors, it is not yet known whether migration status, place of birth, social class at birth and season of birth influence the age at onset of psychotic disorders. This study aimed to determine whether these environmental factors, in addition to cannabis abuse and obstetric complications, influence the age at onset. Additionally, we investigated whether environmental factors could have a cumulative effect on the age at onset. Data was obtained from two first episode of psychosis (FEP) cohort studies. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses. The age at onset was determined for 555 in iduals with a FEP and the median age at onset was 27.3years. In iduals with a history of cannabis abuse had an earlier age at onset by nearly six years. There was a trend for a history of obstetric complications to be associated with a younger age at onset by 2.7years and this was significant in the subgroup with a family history of psychosis. Social class at birth, migration status, place of birth and season of birth were not associated with the age at onset. Exposure to a higher number of environmental factors was associated with an earlier age at onset. Cannabis and obstetric complications are associated with an earlier age at onset and there appears to be a cumulative effect of exposure to multiple environmental factors.
Publisher: JMIR Publications Inc.
Date: 10-07-2019
DOI: 10.2196/13115
Publisher: Wiley
Date: 13-01-2012
DOI: 10.1111/J.1751-7893.2011.00328.X
Abstract: Despite there being approximately 200 early intervention services for psychosis worldwide, little is known about the referral rates to these services, the diagnoses and needs of in iduals found not to have a first episode of psychosis (FEP). Firstly, we aimed to describe the diagnoses for in iduals who were found not to have a FEP (non-cases) following an assessment using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV (SCID). We then aimed to examine the referral rates of cases and non-cases to an early intervention service. All in iduals referred to the early intervention service underwent a clinical assessment using the SCID. In a 4-year period, there were 632 referrals to the early intervention service for psychosis, and of these, 53% (n = 338) were found to have a FEP, 5% (n = 34) were found to have an at-risk mental state for psychosis and 41% (n = 260) were found to be 'non-cases'. This represents a ratio of 1.9:1 of referrals to cases, or approximately 2:1. Of the non-cases, 27% (n = 62) satisfied criteria for a mood disorder, with major depressive disorder the commonest diagnosis. A further 18% (n = 42) of non-cases satisfied criteria for an anxiety disorder and nearly half of these were diagnosed with social phobia. The ratio of referrals to cases was not consistent over time and rose from 1.3:1 in the first year to 2:1 in the fourth year. A large proportion of in iduals referred to an early intervention for psychosis service were found not to have psychotic disorder, however they still have significant needs regarding their mental health.
Publisher: Wiley
Date: 30-10-2021
DOI: 10.1111/EIP.13234
Abstract: Early intervention for people experiencing first episode psychosis is a priority, and keyworkers are vital to such services. However, keyworkers' roles in addressing first episode psychosis patients' physical health are under researched. This study addresses this knowledge gap by evaluating a keyworker‐mediated intervention promoting physical health among first episode psychosis patients. The study was informed by the Medical Research Council's Framework for Complex Interventions to Improve Health. First episode psychosis participants were recruited from three Irish mental health services. The intervention was evaluated in terms of its feasibility/acceptability. Feasibility outcomes were mixed (recruitment rate = 24/68 [35.3%] retention rate = 18/24 [75%]). The baseline s le was predominantly male (M:F ratio = 13:6 Med age = 25 y IQR = 23‐42 y). Common health issues among participants included overweightness/obesity (n = 11) and substance use (smoking/alcohol consumption [n = 19]). Participants' initial health priorities included exercising more (n = 10), improving diet (n = 6), weight loss (n = 7) and using various health/healthcare services. The intervention's acceptability was evidenced by the appreciation participants had for physical health keyworkers' support, as well as the healthy lifestyle, which the intervention promoted. Acceptability was somewhat compromised by a low‐recruitment rate, variable linkages between keyworkers and general practitioners (GPs) and COVID‐19 restrictions. Physical health‐oriented keyworker interventions for first episode psychosis patients show promise and further evaluation of such initiatives is warranted. Future interventions should be mindful of participant recruitment challenges, strategies to enhance relationships between keyworkers and GPs, and if necessary, they should mitigate COVID‐19 restrictions' impacts on care.
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.SCHRES.2015.07.049
Abstract: Formal thought disorder (FTD) is a core feature of psychosis, however there are gaps in our knowledge about its prevalence and factor structure. We had two aims: first, to establish the factor structure of FTD second, to explore the clinical utility of dimensions of FTD in order to further the understanding of its nosology. A cross-validation study was undertaken to establish the factor structure of FTD in first episode psychosis (FEP). The relative utility of FTD categories vs. dimensions across diagnostic categories was investigated. The prevalence of clinically significant FTD in this FEP s le was 21%, although 41% showed evidence of disorganised speech, 20% displayed verbosity and 24% displayed impoverished speech. A 3-factor model was identified as the best fit for FTD, with disorganisation, poverty and verbosity dimensions (GFI=0.99, RMR=0.07). These dimensions of FTD accurately distinguished affective from non-affective diagnostic categories. A categorical approach to FTD assessment was useful in identifying markers of clinical acuteness, as identified by short duration of untreated psychosis (OR=2.94, P<0.01) and inpatient treatment status (OR=3.98, P<0.01). FTD is moderately prevalent and multi-dimensional in FEP. Employing both a dimensional and categorical assessment of FTD gives valuable clinical information, however there may be a need to revise our conceptualisation of the nosology of FTD. The prognostic value of FTD, as well as its neural basis, requires elucidation.
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.SCHRES.2016.09.017
Abstract: Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these outcomes in a first episode psychosis (FEP) s le. A mixed diagnostic FEP cohort was recruited through an Early Intervention in Psychosis Service in Ireland. Participants were assessed at initial presentation and one year later with the MIRECC GAF to evaluate social and occupational functioning domains. Disorganisation (disFTD), verbosity (verFTD) and poverty (povFTD) dimensions of FTD were examined at both time points, as well as a unitary FTD construct. Analyses were controlled for demographic, clinical and treatment variables. DisFTD was the only FTD dimension associated with functional outcome, specifically social functioning, on multivariate analysis (beta=0.13, P<0.05). The unitary FTD construct was not associated with functional outcome. DisFTD at FEP presentation predicted a greater number of hospitalisations (adjusted beta=0.24, P<0.001) and prolonged inpatient admission (adjusted OR=1.08, 95% CI 1.02-1.15, P<0.05) following FEP. Longitudinal and dimensional evaluation of FTD has a clinical utility that is distinct from a cross-sectional or unitary assessment. Dimensions of FTD may map onto different domains of functioning. These findings are supportive of some of the changes in DSM-V with an emphasis on longitudinal and dimensional appraisal of psychopathology. Communication disorders may be considered a potential target for intervention in psychotic disorders.
Publisher: Informa UK Limited
Date: 31-01-2014
DOI: 10.3109/09638237.2013.841864
Abstract: Service user perspectives are essential for the evaluation and development of mental health services. Service users expressing less satisfaction with services subsequently have poorer treatment outcomes. To measure satisfaction with services following psychiatric admission, and to explore its relationship with a number of clinical and service factors. A multi-centre observational study was conducted across three mental health services in Ireland. Service users were interviewed and provided with self-report questionnaires. The Client Satisfaction Questionnaire (CSQ-8) was used to measure treatment satisfaction. The overall level of satisfaction with services was good (CSQ-8 mean score 24.5). Service users who were admitted involuntarily, who experienced physical coercion and lower levels of procedural justice were less satisfied. A better therapeutic relationship, improved insight and better functioning were associated with higher levels of treatment satisfaction. Mental health services should implement strategies to ameliorate the effects of factors associated with lower levels of treatment satisfaction.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.PSYCHRES.2015.07.013
Abstract: Voluntarily admitted service users can report levels of perceived coercion comparable to those admitted involuntarily, yet little is known of this groups longer term outcome. The 'coerced voluntary' had a score of 4 or above on the MacArthur perceived coercion scale and one year after discharge, they had a better therapeutic relationship compared to involuntarily admitted service users. There was no difference between the coerced voluntary, uncoerced voluntary and involuntary groups in engagement, satisfaction and functioning.
Publisher: Wiley
Date: 20-06-2014
DOI: 10.1111/EIP.12063
Abstract: Early intervention (EI) services for psychosis aim to reduce the duration of untreated psychosis (DUP) with intensive large-scale multi-focus initiatives, including public awareness c aigns. As a consequence of this approach, in iduals with a very long DUP who might have otherwise remained undiagnosed may come to medical attention. The aim of this study was to investigate if an EI service detected additional cases of in iduals with a first-episode psychosis (FEP) with a very long DUP and identify demographic and clinical characteristics associated with a very long DUP. We compared the distribution of the DUP in cases with FEP in a cohort from an EI service in a geographically defined catchment area with a historical control group. Participants were interviewed using the Structured Clinical Interview for DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnoses and the Beiser scale to determine the DUP. A total of 172 in iduals were included in the EI service and 151 were included from the historical control. There was no difference in the distribution of the DUP in the EI service compared with the historical control group (χ(2) = 3.77, degrees of freedom (d.f.) = 3, P = 0.29). In the EI service, 7.6% of cases had a DUP between 24 and 35.9 months compared to 3.3% in the historical control, and 13.4% of cases in the EI service had a DUP of greater than three years compared to 10.6% in the historical control. A very long DUP was associated with unemployment, less insight and involuntary treatment. Further examination of the pathways to care in cases with a long DUP may clarify the contribution of help-seeking and health system delays for these in iduals.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.PSYCHRES.2015.05.086
Abstract: Negative symptoms are included in diagnostic manuals as part of criteria for schizophrenia spectrum psychoses only, however some studies have found their presence in other diagnoses. This study sought to clarify negative symptom domain prevalence across diagnostic categories, while investigating whether negative symptoms predicted diagnostic shift over time. Scale for the Assessment of Negative Symptoms (SANS) data were collected at first presentation in 197 in iduals presenting with first episode psychosis and again at one year follow-up assessment. Negative symptoms were highest among in iduals with schizophrenia and among those whose diagnosis shifted from non-schizophrenia spectrum at baseline to schizophrenia spectrum at follow-up. In a non-schizophrenia spectrum group negative symptoms at baseline were not a significant predictor of diagnostic shift to schizophrenia spectrum diagnoses. The study suggests negative symptoms can present among in iduals with non-schizophrenia spectrum diagnoses, although this is most relevant for in iduals following diagnostic shift from non-schizophrenia spectrum to schizophrenia spectrum diagnoses. The findings support introduction of a negative symptom dimension when describing a range of psychotic illnesses, and indicate that further research investigating the evolution of negative symptoms in non-schizophrenia diagnoses is needed.
Publisher: Informa UK Limited
Date: 16-05-2011
DOI: 10.3109/09638237.2011.562263
Abstract: Involuntary admission is one of the most ethically challenging practices in medicine, yet we are only beginning to learn more about the patient's perspective. To investigate (i) peoples' perception of the necessity of their involuntary admission at one year after discharge (ii) readmission rates to hospital and the influence of insight and recovery style. We interviewed in iduals admitted involuntarily at one year following discharge using the Mac Arthur Admission Experience Interview, Birchwood Insight Scale, the Drug Attitude Inventory, Global Assessment of Functioning and the Recovery Style Questionnaire. Sixty-eight people (84%) were re-interviewed at one year and fewer (60%) reported that their involuntary admission had been necessary when compared to inception (72%). Of the 33% that changed their views, most reflected negatively on their involuntary admission. We found that insight was moderately associated with the acknowledgement that the involuntary admission was necessary. Within a year, 43% were readmitted to hospital and half of these admissions were involuntary. In iduals with a sealing over recovery style were at four times the risk of involuntary readmission. Peoples' perception of the necessity of their involuntary admissions is not stable over time and risk of involuntary readmission is associated with recovery style.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for John Paul Lyne.