Now showing 1 - 8 of 8
  • Publication
    National survey of psychiatrists' responses to implementation of the Mental Health Act 2001 in Ireland
    (Springer for the Royal Academy of Medicine in Ireland, 2010-06) ; ;
    Background: Ireland’s Mental Health Act 2001 resulted in substantial changes to mental health services and the process of involuntary admission. Aims: To determine the views of Irish psychiatrists regarding the new legislation, 1 year after full implementation. Methods: We sent questionnaires to all 735 members of the Royal College of Psychiatrists in Ireland. Results: The response rate was 43.7%. As much as 84% of respondents reported satisfaction with training; 69.1% reported increased workloads; 26.8% reported decreased time with service-users; 40.7% reported changes in relationships with service-users (e.g. increased empathy, but more legalistic, conflicted relationships). Almost one in three (27.4%) stated that it was not feasible to implement the Mental Health Act. Negative comments highlighted the adversarial nature of mental health tribunals, effects on therapeutic relationships and issues related to children. Conclusions: The implementation of the Mental Health Act 2001 has resulted in increased workloads, more conflicted relationships with service-users and adversarial mental health tribunals.
      563Scopus© Citations 23
  • Publication
    What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service
    (Springer for the Royal Academy of Medicine in Ireland, 2011-03) ; ; ;
    Aim: This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction. Methods: Patients attending the Mater Misericordiae University Hospital psychiatric outpatient clinics over a 13-week period, and the Mater Misericordiae University Hospital clozapine clinic over a 4-week period and were invited to complete the Barker Scale of Patients' Views Towards Care Received From Psychiatrists. Results: One-hundred and ninety-two patients were invited to participate and there was a response rate of 94%. Eighty-six percent of respondents were satisfied with their care; 92% stated psychiatrists were caring towards them; 85% that psychiatrists know what they are doing; 84% that their illness was explained by their psychiatrist; and 65% that psychiatric care is improving; but 65% stated that psychiatric services are still not good enough. Eighty-six percent were, or had been, in receipt of a psychological treatment. On multi-variable analysis, satisfaction was associated with the view that doctors explained treatment clearly, the view that doctors do not rely excessively on medication, and having been visited by a community mental health nurse. Conclusion: Patients attending psychiatry outpatient services reported a high degree of satisfaction with the treatment they were receiving, although there were discrepancies between satisfaction with their own specific service and with psychiatric services in general.
      266Scopus© Citations 10
  • Publication
    Adjustment disorder considered
    (The Royal College of Psychiatrists, 2013) ;
    Adjustment disorder has been included in psychiatric classifications for over 40 years but has received little attention from the research community. It is particularly common in consultation liaison psychiatry. Evaluation is problematic since it may be mistaken for major depression, generalised anxiety or non-pathological reactions to stress. Its measurement by structured interview is difficult since it is not included in many instruments and, in others, cannot be diagnosed once the threshold for another disorder is reached. There are few evidence-based treatments and it is possible that these transient reactions may not require any formal intervention. Adjustment disorder generally carries an excellent prognosis but in some individuals is associated with self-harm and suicide.                         
      550Scopus© Citations 5
  • Publication
    Undergraduate psychiatry students' attitudes towards teaching methods at an Irish university
    Background: At University College Dublin, teaching in psychiatry includes clinical electives, lectures, small-group and problem-based teaching, consistent with international trends. Aims: To determine final-year psychiatry students’ attitudes towards teaching methods. Methods: We distributed questionnaires to all final-year medical students in two classes (2008 and 2009), after final psychiatry examination (before results) and all of them participated (n = 111). Results: Students’ interest in psychiatry as a career increased during psychiatry teaching. Students rated objective structured clinical examination (OSCE) as the most useful element of teaching and examination. The most common learning style was 'reflector'; the least common was 'pragmatist'. Two thirds believed teaching could be improved (increased patient contact) and 89 % reported that experience of psychiatry changed attitudes towards mental illness (increased understanding). Conclusions: Students’ preference for OSCEs may reflect the closeness of OSCE as a form of learning to OSCE as a form of assessment: OSCEs both focus on specific clinical skills and help prepare for examinations. Future research could usefully examine the extent to which these findings are university-specific or instructor-dependent. Information on the consistency of various teaching, examination and modularisation methods would also be useful.
      306Scopus© Citations 4
  • Publication
    Distinguishing between adjustment disorder and depressive episode in clinical practice: The role of personality disorder
    Background: There is significant symptomatic overlap between diagnostic criteria for adjustment disorder and depressive episode, commonly leading to diagnostic difficulty. Our aim was to clarify the role of personality in making this distinction. Methods: We performed detailed assessments of features of personality disorder, depressive symptoms, social function, social support, life-threatening experiences and diagnosis in individuals with clinical diagnoses of adjustment disorder (n=173) or depressive episode (n=175) presenting at consultation-liaison psychiatry services across 3 sites in Dublin, Ireland. Results: Fifty six per cent of participants with adjustment disorder had likely personality disorder compared with 65% of participants with depressive episode. Compared to participants with depressive episode, those with adjustment disorder had fewer depressive symptoms; fewer problems with social contacts or stress with spare time; and more life events. On multi-variable testing, a clinical diagnosis of adjustment disorder (as opposed to depressive episode) was associated with lower scores for personality disorder and depressive symptoms, and higher scores for life-threatening experiences. Limitations: We used clinical diagnosis as the main diagnostic classification and generalisability may be limited to consultation-liaison psychiatry settings. Conclusions: Despite a substantial rate of likely personality disorder in adjustment disorder, the rate was even higher in depressive episode. Moreover, features of likely personality disorder are more strongly associated with depressive episode than adjustment disorder, even when other distinguishing features (severity of depressive symptoms, life-threatening experiences) are taken into account.
      1206Scopus© Citations 13
  • Publication
    What do you think of us? Evaluating patient knowledge of and satisfaction with a psychiatric outpatient service.
    Aim: This study aimed to measure patient satisfaction with the care they were receiving; examine patients' knowledge of the psychiatric services in general; and identify variables associated with satisfaction. Methods: Patients attending the Mater Misericordiae University Hospital psychiatric outpatient clinics over a 13-week period, and the Mater Misericordiae University Hospital clozapine clinic over a 4-week period and were invited to complete the Barker Scale of Patients' Views Towards Care Received From Psychiatrists. Results: One-hundred and ninety-two patients were invited to participate and there was a response rate of 94%. Eighty-six percent of respondents were satisfied with their care; 92% stated psychiatrists were caring towards them; 85% that psychiatrists know what they are doing; 84% that their illness was explained by their psychiatrist; and 65% that psychiatric care is improving; but 65% stated that psychiatric services are still not good enough. Eighty-six percent were, or had been, in receipt of a psychological treatment. On multi-variable analysis, satisfaction was associated with the view that doctors explained treatment clearly, the view that doctors do not rely excessively on medication, and having been visited by a community mental health nurse. Conclusion: Patients attending psychiatry outpatient services reported a high degree of satisfaction with the treatment they were receiving, although there were discrepancies between satisfaction with their own specific service and with psychiatric services in general.
      346Scopus© Citations 10
  • Publication
    The Role of a Neuropsychiatry Clinic in a Tertiary Referral Teaching Hospital: A Two-Year Study
    Objectives: Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided. Methods: We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82). Results: The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson’s disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history. Conclusion: Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.
      238
  • Publication
    Suicidal behaviours in adjustment disorder and depressive episode
    Background: Little is known about suicidal ideation and behaviours in adjustment disorder (AD). In this paper we sought to examine the variables independently associated with suicidal ideation and behaviour in patients diagnosed with AD or depressive (DE) episode among psychiatric outpatients and in liaison psychiatry. Methods: 370 patients who were referred to the liaison psychiatry services (including those seen in the Emergency Department) at 3 Dublin hospitals, and were clinically diagnosed with either DE or AD, based on the ICD 10 diagnostic criteria, were recruited to the study. We examined their demographic and clinical characteristics, and the associations between these and suicidal ideation and behaviour on multivariate analysis. Results: Younger age, single marital status, and greater severity of depressive symptoms were significantly associated with suicidality across both diagnoses. On multivariate analysis, greater severity of depressive symptoms was associated with suicidality in those with AD (p=0.012) and DE (p=0.009). Those with AD exhibited suicidality at lower symptom scores than did those with DE but in both groups it still occurred at the highest level of severity. There were differences in the objective circumstances measure of suicide intent. Limitations: We used clinical diagnosis rather as the main diagnostic classification. The generalisability of this paper may be limited to consultation-liaison psychiatry settings, where suicidal ideation and behaviours are common. Conclusions: Suicidality in AD and DE has broadly similar risk factors but differ in aspects of suicide intent. Different mechanisms may underpin suicidality in those with AD compared to DE.
      633Scopus© Citations 44