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This study evaluated the real-world effectiveness of mentalization-based treatment by assessing the clinical status of patients before and after completing the treatment program, which was nested within a general adult community mental health service, and by comparing these patients with a treatment-as-usual group.In this retrospective longitudinal naturalistic study, patients with a primary diagnosis of borderline personality disorder received either mentalization-based treatment (N=34) or treatment as usual (N=51). Data were collected from clinical charts and hospital databases. Presentations to the emergency department (ED), psychiatric and medical hospitalizations, and rates of loss to follow-up were analyzed for both groups.In the 2 years after a course of mentalization-based treatment, significant reductions were noted in psychiatric hospitalizations (p=0.018). Compared with the treatment-as-usual group, the intervention group had significant reductions in ED presentations (p=0.004) and medical admissions (p=0.040), when the analysis controlled for age and gender. At study endpoint, the proportion of patients lost to follow-up in the treatment-as-usual group was larger (χMentalization-based treatment embedded within a community mental health team may have a positive effect, with significant improvements in unscheduled service use and notable reductions in ED presentations, hospitalizations, loss to follow-up, and mortality. There may be value in building on this study with more prospective, systematic research and patient-reported outcomes to assess the practical significance of this intervention in general psychiatric settings.

Objective: The COVID-19 pandemic posed new challenges for integrated health care worldwide. Our study aimed to describe newly implemented structures and procedures of psychosocial consultation and liaison (CL) services in Europe and beyond, and to highlight emerging needs for co-operation. Methods: Cross-sectional online survey from June to October 2021, using a self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies, working groups, and heads of CL services. Results: Of the participating 259 CL services from Europe, Iran, and parts of Canada, 222 reported COVID-19 related psychosocial care (COVID-psyCare) in their hospital. Among these, 86.5% indicated that specific COVID-psyCare co-operation structures had been established. 50.8% provided specific COVID-psyCare for patients, 38.2% for relatives, and 77.0% for staff. Over half of the time resources were invested for patients. About a quarter of the time was used for staff, and these interventions, typically associated with the liaison function of CL services, were reported as most useful. Concerning emerging needs, 58.1% of the CL services providing COVID-psyCare expressed wishes for mutual information exchange and support, and 64.0% suggested specific changes or improvements that they considered essential for the future. Conclusion: Over 80% of participating CL services established specific structures to provide COVID-psyCare for patients, their relatives, or staff. Mostly, resources were committed to patient care and specific interventions were largely implemented for staff support. Future development of COVID-psyCare warrants intensified intra- and inter-institutional exchange and co-operation.

BackgroundA need arose to divert patients with psychiatric complaints from the emergency department to alternative settings for psychiatric consultations to reduce footfall during COVID-19. We assessed the effectiveness of alternative referral pathway in reducing COVID-19 infection in our service and its effect on service quality: response time and number of patients leaving before the review. We evaluated the satisfaction of patients, general practitioners (GPs) and mental health service staff with the pathway.MethodsAll patients referred to the mental health service over a 2-month period following the introduction of the pathway were included. Findings were compared against the cohort referred for emergency assessment during the same period in 2019. Feedback surveys were distributed to patients, staff and GPs. χ2 and independent sample t-test were used to compare the variables.ResultsOver 2 months, 255 patients received an emergency assessment via the pathway, representing a 22.3% decrease in the volume of presentations from the same period in 2019. There were no COVID-19 cases among our patients or staff on the roster for assessing patients. In comparison to 2019, response times were improved (pConclusionThe pathway was successful in reducing the spread of infection, improving response times and reducing the numbers of patients who left without an assessment. Given the improved outcomes and acceptability, this is a preferable pathway for emergency referrals into the future.

Objectives:The novel coronavirus 2019 (COVID-19) has spread worldwide threatening human health. To reduce transmission, a ‘lockdown’ was introduced in Ireland between March and May 2020. The aim of this study is to capture the experiences of consultant psychiatrists during lockdown and their perception of it’s impact on mental health services.Methods:A questionnaire designed by the Royal College of Psychiatrists was adapted and circulated to consultant members of the College of Psychiatrists of Ireland following the easing of restrictions. The questionnaire assessed the perceived impact on referral rates, mental health act provision, availability of information technology (IT), consultant well-being and availability of personal protective equipment (PPE). Thematic analysis was employed to analyse free-text sections.Results:Response rate was 32% (n = 197/623). Consultants reported an initial decrease/significant decrease in referrals in the first month of lockdown (68%, n = 95/140) followed by an increase/significant increase in the second month for both new (83%, n = 100/137) and previously attending patients (65%, n = 88/136). Social isolation and reduced face-to-face mental health supports were among the main reasons identified. The needs of children and older adults were highlighted. Most consultants (76%, n = 98/129) felt their working day was affected and their well-being reduced (52%, n = 61/119). The majority felt IT equipment availability was inadequate (67%, n = 88/132). Main themes identified from free-text sections were service management, relationship between patients and healthcare service and effects on consultants’ lives.Conclusions:The COVID-19 pandemic has placed increased pressure on service provision and consultant wellness. This further supports the longstanding need to increase mental health service investment.

Background Covid-19 has placed unprecedented demand on healthcare systems and on healthcare professionals. There have been concerns about the risk of distress, moral injury and burnout among healthcare professionals, especially doctors. Aim To assess the effect of the ongoing Covid-19 pandemic on Irish doctors by investigating the incidence of burnout and long covid among senior medical staff in Ireland. Methods This is a cross-sectional pilot study of the prevalence of burnout and long covid among senior physicians. A survey was sent by email to members of the Irish Hospital Consultant’s Association. The survey included measures of mental and physical health and the 2-item Maslach Burnout Scale (MBS-2). The study explored the experience of delivering health care in the context of a pandemic and experience of the long covid syndrome. Results A total of 114 responses were received. Three-quarters 77% (N = 88) screened positive for burnout on the MBS, with mean score of 5.6 (SD3.3), nearly double the cut-off for burnout. Nearly two-thirds (64%, n = 72) reported that Covid-19 has had an adverse effect on their mental health. One-quarter reported that they or colleagues had experience of ‘long-covid’ secondary to the virus. Conclusion More comprehensive evaluation of the effect of the pandemic on front-line staff is needed to identify the extent of the problem and the factors which contribute to it. This will inform measures to mitigate these effects.

Objectives:This study aimed to assess the impact of COVID-19 on presentations to an acute hospital with self-harm.Methods:All presentations to University Hospital Galway with self-harm were assessed during the peak period of the coronavirus crisis in Ireland, over the 3 months from 1 March to 31 May 2020. These data were compared with presentations in the same months in the 3 years preceding (2017–2019). Data were obtained from the anonymised service database.Results:This study found that in 2020, the rate of presentation with self-harm dropped by 35% from March to April and rose by 104% from April to May, peaking from mid-May. When trends over a 4-year period were examined, there was a significantly higher lethality of attempt (p < 0.001), and significant differences in diagnosis (p = 0.031) in 2020 in comparison with the three previous years. The increased lethality of presentations remained significant after age and gender were controlled for (p = 0.036). There were also significant differences in the underlying psychiatric diagnoses (p = 0.018), notably with a significant increase in substance misuse disorders presenting during the 2020 study period.Conclusions:COVID-19 showed a reduction in self-harm presentations initially, followed by a sharp increase in May 2020. If a period of economic instability follows as predicted, it is likely that this will further impact the mental health of the population, along with rates of self-harm and suicidal behaviours. There is a need for research into the longer-term effect of COVID-19 and lockdown restrictions, especially with respect to self-harm.

Irish Travellers are a marginalised ethnic minority with poor health outcomes, especially in mental health: the suicide rate in this population is 6–7 times that in the general population. There is a paucity of research into associated clinical risk factors including self-harm and mental illnesses. To examine the prevalence and treatments of mental disorders among Travellers attending a community mental health team (CMHT) in Galway. This is a cross-sectional study of the CMHT database, and included all Travellers who were active cases on the study day were included in this study. Travellers formed 12.4% (51 out of 410) of the active caseload of the mental health service. The mean age was 35.7 years (SD 13.1). The most common mental disorder was depressive disorder (16/51, 31.4%). Of 51 patients, 25.5% (13/51) were diagnosed with BPD: 7 had other comorbid mental disorders. Patients diagnosed with BPD are significantly more likely to be prescribed psychopharmacotherapy (t = 2.834, p = 0.007). A diagnosis of BPD was significantly associated with history of self-harm after controlling for age and gender (OR 2.3, p = 0.005). This study shows that there is a significant overrepresentation of Travellers in mental health services, suggesting significant need for accessible and acceptable interventions. Those with a BPD diagnosis have a significantly higher risk of self-harm, representing an ultra-high-risk population. These findings can be used to plan future service development projects to better meet the needs of this population: they may require specially adapted version of the mentalisation-based treatment programme.

This case report highlights the risk of development of Neuroleptic Malignant-Like Syndrome secondary to withdrawal of procyclidine with brief withdrawal of L-dopa and long-term typical antipsychotic depot. The patient responded to reintroduction of procyclidine, sedation and supportive treatment. The mechanism and management of NMS and NMLS is also reviewed. This case emphasises that any changes in antipsychotic and antiparkinsonian medications should be undertaken with extreme caution and patient should be closely monitored for development of NMLS after alteration in these medications.

Background Euthanasia and assisted suicide (EAS) are practices that aim to alleviate the suffering of people with life-limiting illnesses, but are controversial. One area of debate is the relationship between EAS and suicide rates in the population, where there have been claims that availability of EAS will reduce the number of self-initiated deaths (EAS and suicide combined). Others claim that legislation for EAS makes it acceptable to end one's own life, a message at variance with that of suicide prevention campaigns. Aims To examine the relationship between the introduction of EAS and rates of non-assisted suicide and self-initiated death. Method We conducted a systematic review to examine the association between EAS and rates of non-assisted suicide and of self-initiated death. We searched PubMed, Scopus, PsycINFO and Science Direct, until 20 December 2021. Studies that examined EAS and reported data on population-based suicide rates were included. Results Six studies met the inclusion criteria; four reported increases in overall rates of self-initiated death and, in some cases, increased non-assisted suicide. This increase in non-assisted suicide was mostly non-significant when sociodemographic factors were controlled for. Studies from Switzerland and Oregon reported elevated rates of self-initiated death among older women, consistent with higher rates of depressive illnesses in this population. Conclusions The findings of this review do not support the hypothesis that introducing EAS reduces rates of non-assisted suicide. The disproportionate impact on older women indicates unmet suicide prevention needs in this population.

Objective: This study aimed to describe the provision of consultation-liaison psychiatry (CLP, also known as liaison psychiatry) services in acute hospitals in Ireland, and to measure it against recommended resourcing levels.Methods: This is a survey of all acute hospitals in Ireland with Emergency Departments, via an electronic survey sent by email and followed up by telephone calls for missing data. Data were collected on service configuration, activity, and resourcing. Data were collected from CLP or proxy services at all acute hospitals with an Emergency Department in Ireland (n = 29). This study measured staffing and activity levels where available.Results: None of the services met the minimum criteria set out by either national or international guidance per 500 bed general hospital.Conclusions: CLP is a relatively new specialty in Ireland, but there are clear international guidelines about the staffing levels required to run these services safely and effectively. In Ireland, despite clear national guidance on staffing levels, no services are staffed to the levels suggested as the minimum. It is likely that patients in Ireland's acute hospitals have worse outcomes, and hospitals have unnecessary costs, due to this lack. This is the first study of CLP provision in Ireland and demonstrates the resource constraints under which most services work and the heterogeneity of services nationally.

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

IntroductionDespite an evidence base demonstrating simulation to be an effective medical education tool, it is not commonly used in postgraduate psychiatry training as it is in other medical specialties.ObjectiveThis paper outlines the development and effectiveness of a hybrid-virtual simulation-based workshop designed to improve patient care by improving clinical skills of non-consultant hospital doctors (NCHDs) in detecting and managing rare and complex psychiatric emergencies.MethodsThree clinical vignettes based on near-miss psychiatric cases were developed by a multidisciplinary team of physicians and nurses in psychiatry and experts in simulation-based medical education. The workshop, ‘SafePsych’ was delivered in a simulation laboratory while and broadcast via Zoom video-conferencing platform to observers. Debriefing followed each clinical scenario. Participants completed preworkshop and postworkshop questionnaires to evaluate clinical knowledge.ResultsThe workshop was attended by consultants (n=12) and NCHDs in psychiatry and emergency medicine (n=19), and psychiatric nurses (n=5). In the psychiatry NCHD group, test scores significantly improved following the workshop (pConclusionSimulation-based training is effective in teaching high risk, rare complex psychiatric cases to psychiatry NCHDs. Further exploration of the learning needs of nursing staff is required. Future workshop delivery is feasible in the COVID-19 environment and beyond, using a virtual element to meet social distancing requirements while enhancing the reach of the training.

Suicide is a serious problem globally, especially in Europe, with suicide rates varying between different countries. Self-harm is a known risk factor for dying by suicide and represents an opportunity to intervene in order to treat any associated mental illness and reduce risk. This study aimed to compare the characteristics of people presenting to hospital with self-harm at two clinical sites: Galway, Ireland and Kaunas, Lithuania. Data were obtained from the services’ database and anonymised for analysis. Over a 5-month period, 89 patients presented with self-harm at the Lithuanian site and 224 patients presented with self-harm at the Irish site. This study found significant differences in presentation, diagnosis and treatment between the two sites. All patients at the Lithuanian site were admitted to psychiatry, compared to 22% of patients at the Irish site (p &lt, 0.001). In Lithuania, the main clinical diagnoses were adjustment disorder (37.1%) and major depression (20.2%), compared to substance misuse being the main clinical diagnosis (33.8%) in Ireland (p &lt, 0.001). There were significant differences in the prescription of psychotropic medications (which were three times more commonly prescribed at the Lithuanian site) after controlling for age, gender and psychiatric history (p &lt, 0.001). Further research is required to understand the cultural context behind and further association between hospitalisation and future death by suicide.

COVID-19 has presented many challenges to all aspects of the medical environment, including teaching and learning.1 2 Following an almost complete cessation of face-to-face simulation teaching activities in Spring 2020 due to COVID-19, we adapted and turned to the use of creative solutions to teach clinical skills in a safe but effective learning environment. Simulation training in psychiatry has traditionally focused on communication skills teaching and learning.3 4 Previous reports discussed the advantages of simulation as an alternative to role play for providing trainees with clinical experience in a safe learning environment with the potential for improved educational outcomes.5 We outline our experience of running a socially distanced simulation workshop for a multidisciplinary group of learners in psychiatry, combining a small number of in-person learners and a larger number attending synchronously and remotely using Zoom audiovisual technology.6 Galway University Hospitals (GUH) is a tertiary teaching hospital on the west coast of Ireland. It has an on-site simulation facility, the Irish Centre for Applied Patient Safety and Simulation. With the Department of Psychiatry at GUH, they have previously delivered a multidisciplinary simulation workshop on common psychiatric presentations.7 Psychiatry staff were keen to develop a follow-on workshop and to include participants from emergency medicine (EM). Using a collaborative iterative approach, a workshop using simulated patients (SPs) focusing on diagnosis and management of rare but challenging psychiatric emergencies was developed: ‘SafePsych’. Three scenarios, informed by feedback from psychiatry …

We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation–Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent’s University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.

AimsThe objectives of this study were to investigate burnout in a sample of Irish Hospital Consultants and its association with psychopathology (symptoms of depression and anxiety). We examined the effect of personality factors on the development of psychopathology in response to burnout and in relation to work-related stress among the participants.MethodThis is a cross-sectional survey, utilising validated psychometric measures. Self-reported online questionnaires were distributed to all hospital consultants registered with the Irish Hospital Consultants Association distribution list and were completed between September to December 2016. Questionnaires sought to determine demographic information; work-related characteristics; burnout related phenomena: emotional exhaustion, depersonalization, and a reduced sense of personal effectiveness (Maslach Burnout Inventory [MBI-GS]); symptoms of depression and anxiety (Depressive Anxiety Stress Scale [DASS]; and personality characteristics (Big Five Inventory [BFI-10]).ResultA total of 477 hospital consultants (Male = 56.6%) from hospitals in Ireland took part in the study. Of those studied, 42% reported high levels of burnout. The Depression and Anxiety Stress Scale revealed that Consultants were experiencing high levels of stress symptoms but comparatively low levels of anxiety symptoms. The study population scored highest on the conscientiousness and agreeableness subscales and lowest on the neuroticism subscale. Those who scored higher in the neuroticism subtype appeared to be at an increased risk of burnout.ConclusionThe prevalence of work-related burnout in consultants is of concern. The psychological burden of burnout is reflected in reported symptoms of stress and depression. Personality, particularly conscientiousness and agreeableness appears to impact the development of physician burnout. Strategies that modulate the relationship between personality and burnout may be beneficial for optimal health care delivery. Further research is needed to identify appropriate short and long-term strategies to ensure physician wellbeing and optimal delivery of patient care.

Background: Communication skills are essential in a patient-centred health service and therefore in medical teaching. Although significant differences in communication behaviour of male and female students are known, gender differences in the performance of students are still under-reported. The aim of this study was to analyse gender differences in communication skills of medical students in the context of an OSCE exam (OSCE = Objective Structured Clinical Examination).Methods: In a longitudinal trend study based on seven semester-cohorts, it was analysed if there are gender differences in medical students' communication skills. The students (self-perception) and standardized patients (SP) (external perception) were asked to rate the communication skills using uniform questionnaires. Statistical analysis was performed by using frequency analyses and t-tests in SPSS 21.Results: Across all ratings in the self-and the external perception, there was a significant gender difference in favour of female students performing better in the dimensions of empathy, structure, verbal expression and non-verbal expression. The results of male students deteriorated across all dimensions in the external perception between 2011 and 2014.Discussion & conclusion: It is important to consider if gender-specific teaching should be developed, considering the reported differences between female and male students. peer-reviewed

A 73 year old bachelor had multiple presentations to secondary and tertiary care facilities. His symptoms were varied, including headache, falls, marked weight loss and dysarthria. He was investigated as a possible stroke but with subsequent major functional decline. Following extensive investigations and after four months in residential care, major depressive disorder (MDD) was diagnosed. A physical diagnostic label, side effects of, and poor response to, medications complicated the clinical course. Ultimately he was successfully treated with electroconvulsive therapy (ECT). Despite response to ECT, the protracted course contributed to the institutionalisation of the patient. This case highlights the importance of early, accurate diagnosis and effective treatment of depression in older patients.

Background The use of simulation-based education in psychiatry has been increasing in recent years outside of Ireland. Its use has been demonstrated to be an effective means of training in management of acute agitation¹, and advancing communication skills amongst psychiatrists². However, adoption of simulation has been slow in psychiatry training in Ireland. A need was identified for the development of a simulation-based education workshop to improve management of psychiatric emergencies, for trainees new to psychiatry, such as Foundation Year trainees and GP trainees. Summary of project Four scenarios were identified and developed using an iterative collaborative process involving a consultant psychiatrist, psychiatry trainees, psychiatry nurses and simulation staff. The scenarios were: the difficult discharge of a patient; completing an involuntary admission under the Mental Health Act, 2001; management of an acutely agitated patient in the Emergency Department; and risk assessment of a suicidal young man. The scenarios were scripted and actors were trained as simulated persons, and a detailed dry run took place in advance of the workshop. Workshop participants ranged from Foundation Year trainees to Higher Specialist Trainees. Debriefing was led by consultant psychiatrists and the actors. Post workshop satisfaction surveys were circulated and semi-structured reflective interviews were conducted after 3–4 weeks to examine impact on clinical practice. Summary of results Post evaluation data (n=12) was positive with 100% agreeing that the workshop addressed their learning needs. Participants highlighted the benefits of reflection with consultant feedback after each scenario, and an improvement in communication skills. Participants also enjoyed the social aspect of the workshop, and more senior trainees found it a beneficial refresher of basic skills. All wanted further training with suggestions for other scenarios including psychiatry-specific medical emergencies, and assessment of emergency presentations of children and adolescents. Delayed interviews (n=5) showed that participants had applied their learning to their practice in the domains of situational awareness and communication. A handbook was developed following the workshop, detailing the scenarios and including all paperwork relevant to the scenarios, for implementation in other training sites. Discussion, conclusions and recommendations Simulation-based education is a suitable method of training for psychiatric emergencies. The design of a workshop requires detailed scenario development and training of actors in playing simulated persons. There is scope for a roll-out of simulation-based education in post-graduate psychiatry training nationally, supported by the handbook developed from this workshop. References Vestal HS, Sowden G, Nejad S, Stoklosa J, Valcourt SC, Keary C, Caminis A, Huffman J. Simulation-Based Training for Residents in the Management of Acute Agitation: A Cluster Randomized Controlled Trial. Acad Psychiatry. 2017 Feb; 41(1): 62–67. Brenner A. Uses and limitations of simulated patients in psychiatric education. Acad Psychiatry. 2009; 33: 112–119.

Depression is common in the perinatal period, with prevalence rates of 14.4%, but prevalence rates of adjustment disorder in this period have not been established. We aimed to examine the characteristics of women attending a perinatal psychiatry service diagnosed with adjustment disorder (AD) or depressive episodes (DE). The data were collected as part of a multicentre case-control study of 370 patients, 45 of whom were recruited from perinatal psychiatry service at a maternity hospital. We recruited 45 patients with AD or DE diagnosed in the perinatal period and compared them to a matched sample of 109 non-perinatal women. Almost half, 22 (48.9%) perinatal women had a diagnosis of AD and 23 (51.1%) had a diagnosis of DE. Of the perinatal participants, those with AD had more stressful life events, and suicidal ideation and behaviours were three times more common (31.8%) in AD than in DE (8.7%). There were no significant differences in levels of suicidality between the perinatal and the non-perinatal groups. In our cohort, AD is associated with symptoms of depression including suicidal ideation during the perinatal period. Further study is required to examine the relationship between stressors and suicidality in this population.

The effect, if any, of recent economic problems on mental health in the Republic of Ireland is not fully clear. Rates of suicide increased slightly between 2006 and 2011, and there was a notable increase in 2011 itself. Rates of psychiatric admission continued to fall, however, in line with national mental health policy. Use of sedative and tranquilliser medications (but not antidepressants) increased, although use in the Republic of Ireland remains substantially lower than in Northern Ireland. Mean self-rated happiness in Ireland declined steadily and significantly between 2005 and 2012. In 2009, as economic problems deepened, satisfaction with income replaced satisfaction with health as the strongest correlate of happiness in Ireland. By 2011/12, however, none of the traditional correlates of happiness retained an independent association with happiness. Overall, these trends suggest that suicide prevention strategies will be increasingly important for Ireland in future years. Active labour-market programmes to address unemployment may also play an important role in suicide prevention. Rates of mental illness and medication usage in the community merit further study. The solution to declining happiness levels may elude purposive description but this trend is likely to reverse as Ireland’s economic prospects improve.

Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.

Most studies into the role of religiousness in relation to depression severity have mainly found an inverse relationship between greater religiousness and lower levels of depressive symptoms. There is reason to assume that religiousness has a buffering effect on the relationship between stressful life events and depressive symptoms. The aim of this study was to investigate the role of religiousness in moderating the impact of stressors on depressive symptoms. n = 348 patients with either a depressive episode or adjustment disorder were assessed at referral to the liaison psychiatry services in three Dublin hospitals and n = 132 patients were followed up six months later. We assessed depressive symptoms, life events, social support, and religiosity, and used hierarchical and multiple linear regression for data analysis. The interaction of organised religious activity and the amount of life events was significant (&beta, = &minus, 0.19, p = 0.001) in the cross-sectional prediction of depressive symptoms while non-organised religious activity (&beta, 0.23, p = 0.001) and intrinsic religiousness (&beta, 0.15, p = 0.033) interacted significantly with life events in the longitudinal analysis. This study demonstrated that various dimensions of religiousness buffered the impact of life events on outcome.

Recent estimates suggest that up to 34% of frontline workers in healthcare (FLWs) at the forefront of the COVID-19 pandemic response are reporting elevated symptoms of psychological distress due to resource constraints, ineffective treatments, and concerns about self-contamination. However, little systematic research has been carried out to assess the mental health needs of FLWs in Europe, or the extent of psychological suffering in FLWs within different European countries of varying outbreak severity. Accordingly, this project will employ a mixed-methods approach over three work packages to develop best-practice guidelines for alleviating psychological distress in FLWs during the different phases of the pandemic. Work package 1 will identify the point and long-term prevalence of psychological distress symptoms in a sample of Irish and Italian FLWs, and the predictors of these symptoms. Work package 2 will perform a qualitative needs assessment on a sample of Irish and Italian FLWs to identify sources of stress and resilience, barriers to psychological care, and optimal strategies for alleviating psychological distress in relation to the COVID-19 pandemic. Work package 3 will synthesise the findings from the preceding work packages to draft best practice guidelines, which will be co-created by a multidisciplinary panel of experts using the Delphi method. The guidelines will provide clinicians with a framework for alleviating psychological distress in FLWs, with particular relevance to the COVID-19 pandemic, but may also have relevance for future pandemics and other public health emergencies.

Depression is common: it affects one-quarter of those in palliative care.1 2 It may be associated with suicidal ideation or may have repercussions for treatment decision-making. Anxiety and depression are treatable (even in this population) with remission rates of >50% at 4 weeks.1 Depression is associated with reduced quality of life (QoL) and increased mortality, and along with anxiety, is an important target symptom for intervention.3 They are frequently underdetected and undertreated in palliative care.4 Detection may be difficult due to diagnostic overshadowing—somatic symptoms may arise from depression, high symptom burden or even treatment side effects. The European Clinical Guidelines for the Management of Depression in Palliative Care emphasises screening and a high clinical suspicion for anxiety and depression, given their prevalence.5 They recommend the Hospital Anxiety and Depression Scale (HADS) to screen for depression, as it has minimal focus on somatic symptoms.5 In a pilot study, we examined the acceptability of the HADS, along with a brief QoL measure, to screen for anxiety and depression across both hospital and hospice …

Background: In this paper, we aimed to examine the patterns of sleep disturbance in adjustment disorder (AD) and depressive episode (DE), to examine the variables associated with sleep disturbance in AD and DE and associated impairment in functioning. Methods: This is a multi-centre case-control study of 370 patients: 185 patients with AD and 185 patients with a diagnosis of DE, recruited from the liaison psychiatry services of three Dublin hospitals. We examined the participants&rsquo, sleep pathology using the sleep disturbance items on the Schedule for Clinical Assessment in Neuropsychiatry, and the Inventory of Depressive Symptoms&mdash, Clinician-rated-30. Results: Patients with a diagnosis of AD were less likely to report disturbed sleep than those with a diagnosis of DE (p = 0.002). On multivariate analysis, sleep disturbance was significantly associated with greater severity of certain depressive symptoms: decreased appetite (p &lt, 0.001) and psychomotor agitation (p = 0.009). Decreased appetite, younger age and single marital status were significantly associated with sleep disturbance in male patients, and decreased appetite and psychomotor agitation were significantly associated with sleep disturbance in female participants. Conclusions: This is the largest study to date which has examined sleep disturbance in adjustment disorder. Disturbance of sleep is a significant symptom in AD and may represent a potential target for treatment. With further research, patterns of sleep disturbance may be useful in differentiating AD from DE.

Introduction Lithium is a medication indicated for the treatment of bipolar disorder and treatment-resistant depression, with a narrow therapeutic index. Overdose, either acute or chronic can result in neurological symptoms, requiring dialysis and admission to intensive care in some cases. Lithium toxicity is avoidable with careful monitoring. However, we have noted several recent cases of lithium toxicity in our local service and thus sought to investigate this issue in a more systematic manner.Aim We aimed to quantify the incidence of lithium toxicity in our local population over a single year and identify the patients most at risk. We also aimed to generate clinical recommendations on the prevention of lithium toxicity to improve patient safety.Method We identified the incidence of lithium toxicity in our local population, by searching the hospital pathology database for patients with serum lithium levels greater than 1.0 mmol/L. We examined the available clinical notes for these patients.Results We identified 74 serum lithium readings above 1.0 mmol/L measured in 44 individual patients. The highest recorded level was 3.2 mmol/L. Of these, 11 patients were aged 65years or older. Hospital admission was required in 14 cases. There were missing data of note: 29.5% had no renal function/eGFR measurement at time of toxicity and 52.3% without a baseline eGFR.Conclusion Lithium toxicity is common in our population. Given the narrow therapeutic index, this demonstrates the need for careful monitoring and prescribing, especially patients aged 65 and over. Grant supplied by Undergraduate Research Committee, School of Medicine, National University of Ireland, Galway. peer-reviewed 2020-01-10

“People with mental health problems are particularly vulnerable to social exclusion” – Vision for Change.People with mental health problems are very vulnerable. However those with mental health problems who have additional social problems are even more vulnerable.Currently psychiatric services in Ireland are provided on a ‘catchment area’ basis, with a consultant psychiatrist leading a multi-disciplinary team providing a service to the population of a defined geographical area. These services comprise both outpatient and inpatient care, and there is significant regional variation in terms of both bed availability and multidisciplinary team staffing. Sub-specialities, with the exception of child psychiatry and psychiatry of old age, are often unavailable, particularly outside Dublin. In such cases, some additional duties (eg. liaison, rehabilitation, perinatal) are assumed by the local general adult services.However, the overall distribution of services is uneven. Instead of services being concentrated upon those areas of greatest need, the opposite is often the case, with the most deprived areas having the least services in terms of acute beds and community mental health teams per thousand people. These areas also have less psychological services and specialist services despite increased levels of mental illness.Within this vulnerable population there are a number of sub-groups who are even further marginalised, and for whom there are significant barriers both at point of contact with services and with accessing appropriate follow up services. These include the homeless, the ever-increasing cohort of migrants to this country, those in prison and children and adolescents. Stigma and discrimination are the greatest barriers to social inclusion, quality of life and recovery for people with mental illness.

Objectives Burnout is prevalent among doctors and affects the quality of patient care. Little research on burnout in consultant-level doctors has been done. The objective of this study was to measure burnout in the hospital consultant population in Ireland.Methods Surveys were distributed to consultants in Ireland from September to December 2016. The anonymous online survey combined demographic questions and the Maslach Burnout Inventory General Survey.Results Four hundred seventy-seven (22%) consultants completed the survey. Of these, 42% reported high levels of burnout. We found that face-to-face contact with patients, specialty, exercise, remuneration and type of contract influenced burnout levels.Conclusions This study demonstrated that over 40% of the consultants studied are affected by burnout. This finding raises concerns for patient safety and standard of care as well as doctors well-being. Interventions to address and minimise burnout are important to guarantee high patient outcomes and retain medical staff. peer-reviewed

Objective Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. Methods The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. Conclusion At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities.

3DFD (3 Dimensions of Care for Diabetes) is an award winning gold-standard model of integrated care, which was developed and evaluated as a sustainable service for improving glycaemic control and reducing diabetes complications in South London's multi-ethnic, socio-economically disadvantaged and growing diabetes population. This service is fully integrated into the diabetes services across Lambeth and Southwark boroughs. It consists of a liaison psychiatrist who provides clinical leadership and psychiatric interventions, psychologists and two third-sector social support workers who provide social care in the community, working directly with the diabetes teams across the sectors. 3DFD has completed two consecutive pilot phases during which the components of the service have been refined and effectiveness demonstrated. We found high levels of mental illness and unmet need, and effected improvements in glycaemic control, psychological status and health service use. We have produced outcomes which compare favourably with new antidiabetic medications to the market and to the outcomes of the local intermediate teams. We believe this provides the best possible model of care for patients with persistent poor diabetes control despite implementing standard pathways. The full economic evaluation is in progress and preliminary analyses indicate that there will be an annual saving of £33 000, based on the reduction in HbA1c from the first pilot. Copyright © 2015 John Wiley & Sons.

SummaryDiabetes is an increasingly common health problem, especially in the West, where there is an emerging epidemic of type 2 diabetes, closely related to the epidemic of obesity. Many people with diabetes struggle to optimise their diabetes control, often because they also have mental illnesses or psychological and social problems. Poor diabetes control has significant consequences for the individual, and if not addressed will result in complications that include blindness, kidney failure and even amputations. There are also consequences for health services resulting from increased admissions and emergency department presentations with diabetes-related difficulties. In the long-term, the costs associated with complications such as renal failure and amputation are high. Addressing the psychiatric and psychological barriers to good glucose control can help reduce the burden of diabetes and its complications on both the individual and the health service.

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. Language: en

Depression is associated with increased morbidity, mortality and hospital readmission in patients with heart failure (HF). This systematic review aimed to compile studies examining whether the use of antidepressants could improve outcome in patients with HF and concomitant depression. The electronic libraries Embase, OVID MEDLINE(R) and PsychInfo were used to search the following terms 'heart failure' AND 'anti-depressants'; 'heart failure' AND 'TCA' OR 'SSRI' OR 'SNRI'. The result of this database search was analysed to select papers that satisfied our inclusion criteria. Of the 180 papers found in the original database search, only three met the inclusion criteria. A further two papers were added from hand-searching through the references. Three of these papers are randomised controlled trials (RCT); the other two, cohort studies. All studies show that antidepressants are well tolerated in this group. There was no significant difference in depressive symptoms between the test and placebo. The cardiac outcomes of patients with HF are not improved by the use of antidepressants relative to placebo. Antidepressants are not associated with increased mortality rate as established in previous papers. However, there is inadequate evidence that the use of antidepressants effects significant improvement in depression or cardiac outcomes. peer-reviewed