Kelly, Brendan D.
Kelly, Brendan D.
Kelly, Brendan D.
Now showing 1 - 10 of 17
- PublicationThe Role of a Neuropsychiatry Clinic in a Tertiary Referral Teaching Hospital: A Two-Year StudyObjectives: 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.
- PublicationNational survey of psychiatrists' responses to implementation of the Mental Health Act 2001 in IrelandBackground: 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.
Scopus© Citations 24 692
- PublicationCan adjustment disorders and depressive episodes be distinguished? Results from ODINBackground: No large-scale epidemiological study has included adjustment disorders (AD) for consideration yet it is considered to be a common psychiatric diagnosis. Methods:Using a two stage screening method, those above a threshold score for possible caseness on the Beck Depression Inventory (BDI), were interviewed using SCAN to identify those with depressive episode and AD. Variables that might distinguish AD from depressive episode were examined. Results:The prevalence of AD was extremely low with one centre having no cases. Finland, the country with the highest prevalence, only achieved a frequency of 0.8% and 1%, respectively, for urban and rural sites. Logistic regression failed to identify any variables that independently differentiated AD from depressive episode. Findings relating to severity of symptoms using BDI were robust. Limitations: The small sample size might have contributed to a failure to identify distinguishing features between AD and other disorders. Conclusions:Reasons for the failure of even robust results, such as BDI severity, to distinguish AD from depressive episode are considered of which problems in conceptualising AD are the most likely. Further studies are required.
Scopus© Citations 89 716
- PublicationUse of Power Flow Controllers to Enhance Transmission Network Utilisation on the Irish Transmission NetworkThe Ireland and Northern Ireland power system is in a period of rapid transition from conventional generation to renewable generation and has seen a rapid increase in large demand sites requiring connection into the backbone transmission system. The role of EirGrid and SONI as Transmission System Operator in Ireland and Northern Ireland is to operate, maintain and develop the electricity transmission network. EirGrid ensure that new transmission projects are developed in a way that balances technical, economic, community and other stakeholder considerations. This has resulted in much more detailed evaluation of planning options to maximize utilisation of the existing network which may include but are not limited to uprating the capacity of the existing transmission system mainly through the thermal or voltage uprate of existing circuits. Another method to increase network utilisation is to strategically deploy Power Flow Control devices to relieve system overloads and maximise network transfer capacities. EirGrid has developed a new grid development strategy which places particular emphasis on identifying technologies to help resolve network issues. This paper presents the study findings for application of power flow controller (PFC) to relieve system issues.
- PublicationFactors associated with suicidal ideation in the general population : Five-centre analysis from the ODIN studyBackground: Very few studies have examined the cross-national prevalence of suicidal ideation in the general population or variables associated with it. Aims: To examine the risk factors for suicidal ideas in the general population. Method: As part of a five-country two stage epidemiological study of depressive disorder (the ODIN study) a random sample of over 12 000 people were screened using the Beck Depression Inventory (BDI). There followed detailed analysis of item 9 of the BDI, which measured the severity of suicidal ideation. Results: Age, marriage, concern by others and severity of depressed mood independently increased or decreased the odds of suicidal ideation overall. An interaction between life events and social supports was identified, although this differed between men and women. Only concern by others and severity of depression were independently associated with serious suicidal ideation. The study does not allow for interpretation of the direction of the association. Conclusions: A number of social, clinical and demographic variables were independently associated with all suicidal ideation and with serious suicidal ideation. Longitudinal studies are required to confirm whether these are risk factors for or the result of suicidal ideation or have some other relationship.
438Scopus© Citations 104
- PublicationWritten information on bipolar affective disorder: the patients' perspectiveAims and method: The mental health information available to people with bipolar affective disorder is variable in quality. We conducted a qualitative survey in an urban out-patient department to elicit the opinions of people with bipolar affective disorder on the written information provided by three health information providers.Results: Participants’ responses were generally positive for each leaflet. The two leaflets rated highest by participants used quality assurance tools. However, 20-30% had difficulty understanding the leaflets. Medical jargon and verbosity were common criticisms. Clinical implications: Professional bodies such as the Royal College of Psychiatrists play an important role in providing patients with written information. Quality assurance standards should be used in the production of patient information. A tool measuring individuals’ appraisal of information may ensure information is appropriate to their requirements.
344Scopus© Citations 1
- PublicationApplications for fees waivers on medical and psychiatric grounds at an Irish third-level collegeBackground: Physical and mental illness present substantial challenges to college students and authorities. Aims: (1) To characterize medical and psychiatric reasons underlying requests for fees waivers at an Irish third-level college; (2) to identify information included in applications; and (3) to develop proposals for standardizing applications. Methods: We examined all applications for exemption from fees for medical or psychiatric reasons over two academic years at an Irish third-level college. Results: Two hundred and twenty-two students applied for exemptions; 91% were successful. Psychiatric problems were more common than physical illness (64.1 vs. 27.9%). There was wide variation in details provided in applications with few providing details on likely ongoing duration of illness (5.0%). Conclusions: We recommend that (a) a structured medical application form be completed by medical practitioners supporting applications; (b) a medical practitioner review applications; and (c) there should be annual re-audit of this process.
- PublicationWhat 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.
Scopus© Citations 10 453
- PublicationSocial capital and suicide in 11 European countries: an ecological analysisBackground: 'Social capital' refers to the existence of voluntary community networks and relationships based on trust, and the use of these networks and relationships to enable positive social action. Social capital is positively associated with selected indices of mental health. Methods: We performed an ecological investigation of the relationship between social trust (as one component of social capital) and national suicide rates in 11 European countries (n=22,227). Results: There was an inverse relationship between social trust and national suicide rates (i.e. the higher the social trust, the lower was the suicide rate), after controlling for gender, age, marriage rates, standardised income and reported sadness. Conclusions: Social capital may have a protective effect against suicide at the national level. Multi-level analysis, taking into account both group-level and individual-level variables, would help clarify this relationship further and guide appropriate interventions at both the group and individual levels.
817Scopus© Citations 72
- PublicationDistinguishing between adjustment disorder and depressive episode in clinical practice: The role of personality disorderBackground: 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.
Scopus© Citations 17 1338