Now showing 1 - 10 of 33
  • Publication
    I'm spiritual but not religious : Implications for research and practice
    (SCM Press, 2013-05)
    There is an assumption, amongst some mental health service users, clinicians, researchers and others, that religiousness and spirituality are the same construct. A consideration of the history of these concepts shows that, over time, each has become separated from the other. Both require careful definition. The definitions of spirituality are heterogeneous and, with important implications for research and practice, some encompass mood states. The failure to separate spirituality and religiousness, and the confounding of spirituality with mood states in some research in psychiatry, makes interpretation of the findings difficult. Greater clarity and precision will be required in future research including, if possible, attempts to provide distinctive operational definitions of spirituality and religiousness.                          
  • Publication
    Peer reviewing made easy
    (Royal College of Psychiatrists, 2011) ; ; ;
    Peer review in scientific journals has existed for over 200 years. This process is currently the accepted way of assessing scientific manuscripts prior to publication for most journals. Despite this, little has been written about the process of peer reviewing, with hardly anything specific to psychiatric journals. This article answers fundamental questions related to peer reviewing and includes practical tips to writing reviews. It will be helpful for those keen on improving their knowledge about the peer-review process. It will not only benefit those who are reviewers or thinking about becoming reviewers, but also authors, who can use the information to improve their chances of publication.                    
      1032Scopus© Citations 4
  • Publication
    The role of personality disorder in 'difficult to reach' patients with depression: Findings from the ODIN study
    Individuals with personality disorders (especially paranoid personality disorder) tend to be reluctant to engage in treatment. This paper aimed to elucidate the role of personality disorder in predicting engagement with psychological treatment for depression. The Outcomes of Depression International Network (ODIN) involves six urban and three rural study sites throughout Europe at which cases of depression were identified through a two-stage community survey. One patient in seven who was offered psychological treatment for depression had a comorbid diagnosis of personality disorder (most commonly paranoid personality disorder). Forty-five percent of patients who were offered psychological treatment for depression did not complete treatment. The odds of completion were higher for patients with a comorbid diagnosis of personality disorder, especially paranoid, anxious or dependent personality disorder. The relatively low number of cases with some specific personality disorders (e.g. schizoid personality disorder) limited the study's power to reach conclusions about these specific disorders. This study focused on a community-based sample which may lead to apparently lower rates of engagement when compared to studies based on treatment-seeking populations. Episodes of depression in the context of personality disorder may represent a valuable opportunity to engage with patients who might otherwise resist engagement.
      376Scopus© Citations 3
  • Publication
    Media and the Coverage of Psychiatry
    (Doctors Academy Group of Educational Establishments, 2014-12) ; ; ;
    Background and aim: Psychiatric issues have often been a focus for the media. Studies have differed in their findings about how the subject matter is portrayed in newspapers.We compared tone and content of Irish print with the British, broadsheets and tabloids, and the coverage of physical and mental illness. Methods: A selection of Irish and British broadsheet and tabloid newspapers were examined page by page by researchers for period of 6 months. Various parameters investigated including who the authors were, commenting on the tone, focus and topic of the articles. A comparison of the parameters between the two countries was made. Results: The total numbers of newspapers studied in six months were 579. In comparison the tone of heading and article was neutral for both Irish and English articles. The tone was more negative (and sensationlist) on tabloids compared to dailies and Sunday newpapers. Predominantly for articles related to mental and physical illnesses tone of headline and article itself was neutral in daily and Sunday broadsheets and dramatic in daily tabloids. Conclusions: To ensure accuracy of information and a more balanced article, we feel more articles should be written by health care professionals themselves, especially for tabloids. Databases now exist where journalists can contact the health care professionals for various illnesses.
  • Publication
    Risk Factors of Postpartum Depression in Rural Areas of Isfahan Province, Iran
    (Academy of the Medical Sciences of the I.R. Iran, 2009-09) ; ; ; ;
    Background: Postpartum depression is defined as a major depressive episode that occurs within four weeks after delivery. However, investigators describe a dramatic increase in the incidence of mood disorders after childbirth with the largest risk during 90 days after delivery. We aimed to study the risk factors of postpartum depression in women living in rural areas of Isfahan Province in Iran. Methods: We assessed 6627 women, two to 12 months after delivery, for depression and putative risk factors. Results: Unemployment, low education, mothers' young age, undesired gender of the child, unplanned pregnancy, and history of depression were the main risk factors of postpartum depression. History of depression, low education, primiparity, unplanned pregnancy, and undesired gender of the child had the highest risk score for postpartum depression in this group of Iranian women. Conclusion: Risk factors of postpartum depression in Isfahan Province were very similar to other studies, but the negative impact of low level of education, unplanned pregnancy, and undesired gender of the child on postnatal depression seems to be characteristic of this population.
  • Publication
    Adjustment disorders with depressed mood: A critique of its DSM-IV and ICD-10 conceptualization and recommendations for the future
    Background: The volume of research involving adjustment disorder (AD) is limited. The scientific neglect of AD seems to result from the inadequate operationalisation of AD in DSM-IV and ICD-10. The aims of the present proposal are to discuss the shortcomings of AD conceptualisations and to present recommendations for the future. Sampling and methods: This conceptual paper is based on an iterative process of debate between the authors. Results: The current operational definition of AD is characterised by 3 main limitations: (1) the inadequately defined clinical significance criterion, (2) the relegation of AD behind other diagnoses and (3) the missed recognition of the importance of contextual factors, such that normal human adaptive processes might be pathologised. Furthermore, subtypes of AD lack operational clarity. Based on a discussion of the limitations, recommendations for DSM-V are presented, including the addition of new subtypes. Conclusions: The revision of AD criteria will reduce the likelihood of false-positive and false-negative diagnoses. These changes will enable the scientific exploration of this common and relevant disorder, and will make epidemiological studies, and ultimately service planning based on these, more reliable than at present.
      1341Scopus© Citations 64
  • Publication
    Adjustment disorder: epidemiology, diagnosis and treatment
    (Springer, 2009-11)
    Adjustment disorder was introduced into the psychiatric classification systems almost 30 years ago, although the concept was recognized for many years before that. In DSM-IV, six subtypes are described based on the predominant symptoms, but no further diagnostic criteria are offered to assist the clinician. These are common conditions, especially in primary care and in consultation liaison psychiatry, where the prevalence ranges from 11% to 18% and from 10% to 35%, respectively. Yet they are under-researched, possibly due to the failure of some of the common diagnostic tools to allow for the diagnosis of adjustment disorder. Among the tools that incorporate adjustment disorder, the concordance between the clinical and interview diagnosis is very poor, with the diagnosis being made more commonly in clinical practice than the diagnostic tools allow for. Adjustment disorder is found in all cultures and in all age groups. The presence of a causal stressor is essential before a diagnosis of adjustment disorder can be made, while the symptoms vary and include those that are found in other common psychiatric disorders. It is also important to distinguish adjustment disorder from normal reactions to stressful events. Adjustment disorders are difficult to distinguish from normal responses to life's stressors, while the distinction from major depression also poses a classificatory conundrum since both are conceptually different. Adjustment disorder is a diagnosis based on the longitudinal course of symptoms in the context of a stressor, while a diagnosis of major depression is a cross-sectional one based on symptom numbers. Treatments consist mainly of brief interventions, while pharmacotherapy is limited to the symptomatic management of anxiety or insomnia. There are no robust studies demonstrating benefits from antidepressants. However, the number of studies of either type of intervention is very limited.
      4005Scopus© Citations 58
  • Publication
    Impact of severity of personality disorder on the outcome of depression
    The influence of severity of personality disorder on outcome of depression is unclear. Four hundred and ten patients with depression in 9 urban and rural communities in Finland, Ireland, Norway, Spain and the United Kingdom, were randomised to individual problem-solving treatment (n = 121), group sessions on depression prevention (n = 106) or treatment as usual (n = 183). Depressive symptoms were recorded at baseline, 6 and 12 months. Personality assessment was performed using the Personality Assessment Schedule and analysed by severity (no personality disorder, personality difficulty, simple personality disorder, complex personality disorder). Complete personality assessments were performed on 301 individuals of whom 49.8% had no personality disorder; 19.3% had personality difficulties; 13.0% had simple personality disorder; and 17.9% had complex personality disorder. Severity of personality disorder was correlated with Beck Depression Inventory (BDI) scores at baseline (Spearman's r = 0.21; p < 0.001), 6 months (r = 0.14; p = 0.02) and 12 months (r = 0.21; p = 0.001). On multi-variable analysis, BDI at baseline (p < 0.001) and type of treatment offered (individual therapy, group therapy, treatment as usual) (p = 0.01) were significant independent predictors of BDI at 6 months. BDI at baseline was the sole significant independent predictor of BDI at 12 months (p < 0.001). There was no interaction between personality disorder and treatment type for depression. While multi-variable analyses indicate that depressive symptoms at baseline are the strongest predictor of depressive symptoms at 6 and 12 months, the strong correlations between severity of personality disorder and depressive symptoms make it difficult to establish the independent effect of personality disorder on outcome of depression.
      433Scopus© Citations 18
  • Publication
    Written information on bipolar affective disorder: the patients' perspective
    Aims 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.
      299Scopus© Citations 1
  • 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.