To send this article to your account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about sending content to .
To send this article to your Kindle, first ensure firstname.lastname@example.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.
Find out more about sending to your Kindle.
Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Client Satisfaction with services is an important predictor of health care seeking, treatment compliance and health status outcome. Given that both parents and young people may have different views of services offered, this study examines both perspectives with respect to Child and Adolescent Mental Health Services (CAMHS) in Ireland.
Following ethical approval, the Client Satisfaction Questionnaire-8 (CSQ-8) were sent to all open cases attending three urban CAMHS. Returned questionnaires were received from 426 (280 parents and 146 adolescents) giving a response rate of 49%.
No significant differences were observed between parents and adolescents regarding general satisfaction with CAMHS (Mann–Whitney U-test; Z=−0.255; p=0.799) with a range of good and excellent ratings between 77.1% (for the extent that program met user’s needs) and 93.1% (for recommendation of program to a friend). Significant positive associations were found between age of child (Spearman’s ρ=0.159; p=0.017), receiving a diagnosis (Mann–Whitney U-test; Z=−2.14; p=0.032), frequent attendance (χ2=8.74; df=3; p=0.033) and living in close proximity to the service (χ2=9.24; df=3; p=0.026). There was a strong negative correlation between reduction in impairment and levels of satisfaction (ρ=−0.44, n=275, p<0.000). Waiting time or duration in service were not associated with CSQ and 53% (145) requested clinic opening hours outside of 09:00 a.m. to 17:00 p.m.
Regular user feedback, a robust and distinct measure of service quality, will ensure the development of effective, accessible, client-centered and responsive services, which can evolve in partnership with families and young people.
People with Down syndrome (DS) are at high risk for developing dementia and early diagnosis is vital in enhancing quality of life. Our aim was to compare our practice to consensus recommendations on evaluation, diagnosis and pharmacological treatment of individuals with DS who develop dementia. We also aimed to establish the average time taken to make a diagnosis of dementia and to commence pharmacotherapy, and to assess tolerability to acetylcholinesterase inhibitors.
Retrospective chart review in an exhaustive sample containing all current service users attending our service with DS and a diagnosis of dementia (n=20).
The sample was 75% female and 70% had a moderate intellectual disability. The average age at diagnosis of dementia was 52.42 years old. The average time to diagnosis from first symptom was 1.13 years and the average time to commence pharmacotherapy was 0.23 years. A total of 17 patients commenced on acetylcholinesterase inhibitors, and of these seven discontinued medication due to side-effects or lack of efficacy.
The results on anticholinesterases add to the limited pool of data on treatment of dementia in DS. There was an identified need to improve the rates of medical, vision and hearing assessments, and prospective screening. Deficiencies in screening and diagnosis may be addressed by implementing a standardised dementia assessment pathway to include prospective screening and longitudinal assessment using easily administered scales. We highlight the importance of improving the diagnostic process, as a vital window of opportunity to commence a comprehensive care plan may be lost.
There is a dearth of information relating to the prevalence of housing needs among psychiatric in-patients in Ireland. Most of the information we have to date emerged as a result of attempts to plan for the closure of old psychiatric hospitals and inappropriate community residences. This study sought to identify the prevalence of housing needs among in-patients in the acute psychiatric unit in Tallaght Hospital.
Each week, over a 12-month period, nursing managers and/or key nurses who knew the patients well were asked for numerical data. Information was collected on the numbers of in-patients with accommodation needs, number of delayed discharges due to accommodation needs and number of discharges to homeless accommodation in the previous week.
On average, 38% of in-patients had accommodation related needs at any one time. Most (98%) of delayed discharges had accommodation related needs. Delayed discharge in-patients with accommodation needs accounted for 28% of all inpatients and for 72% of all inpatients with accommodation related needs.
Accommodation need among psychiatric in-patients is underreported. Housing need data should be routinely collected and effective interagency strategies developed to address housing needs.
Movement disorders are a common problem in those receiving antipsychotic medication. Clinical guidelines recommend that these side-effects are monitored regularly throughout treatment. However, due to a lack of training, clinician confidence levels in assessment are often low and regular monitoring may be neglected.
To audit current practice in our services regarding monitoring of extrapyramidal side effects (EPSE) and improve monitoring through education of clinicians.
The clinical records of patients receiving antipsychotic treatment, seen in the outpatient clinic over a 2-week period, were reviewed. Data were collected on whether or not EPSE had been assessed. A re-audit was undertaken following a teaching session.
Documentation regarding EPSE was present in only 14% of patient records. Following a teaching session, the overall level of documentation of EPSE rose to 42%, with rates of assessment dramatically improving in non-consultant hospital doctors.
In our practice, clinicians are generally poor to assess and record EPSE. However, rates of assessment improved significantly following a teaching session, especially in NCHDs.
Guidelines on advising patients on fitness to drive have been published recently by the Road Safety Authority in collaboration with the Royal College of Physicians of Ireland. The aim of this audit is to assess if the new guidelines are being adhered to.
Examination of the documentation and adherence to the guidelines in the inpatient psychiatric unit, Mayo General Hospital.
Of the 100 patients included in audit cycle one, none had any specific documentation about driving. One patient was admitted with alcohol misuse and was driving. On re-auditing, following presentation at academic meeting and education of team members on the guidelines, there was a minor improvement of 7%.
There was no significant difference in documentation on re-audit. However, an increase of 7% is nonetheless encouraging. Information concerning driving should be a standard part of advice given to all psychiatric patients.
Mirtazapine is indicated in the treatment of major depressive disorder particularly in selective serotonin re-uptake inhibitors resistance. Its effect on hair loss is rare with no previous documented effect on hair colour.
Review of relevant literature and description of a case report of a 54-year-old male patient who developed alopecia and hair discoloration after initiation of mirtazapine treatment.
Upon cessation of mirtazapine treatment full restoration of hair colour and regrowth of hair was attained within 10 weeks.
There was clear temporal relationship between experiencing hair loss and commencing mirtazapine treatment. No other more likely medical reason to explain such experience was established. A noticeable restoration of the hair colour occurred following mirtazapine cessation.
Mirtazapine is associated with hair discoloration and hair loss. The possibility of such distressing adverse effects needs to be conveyed to patients by clinicians and to be further explored by researchers.
It is widely accepted that people with mental illness have increased risk of cardiometabolic complications such as obesity and type 2 diabetes mellitus. What is less well known is that individuals with diabetes have an increased risk of brain health complications including depression, cognitive impairment and dementia. These conditions can adversely influence disease self-management and further increase risk of other diabetes complications.
The aim of this paper is to highlight the increased risk of brain health complications in populations with diabetes in order to promote awareness of such complications among healthcare professionals and encourage timely intervention.
An overview of the prevalence and potential mechanisms linking depression and cognitive impairment with diabetes as well as implications for detection, management and brain health protection, based on a narrative review of the literature.
Early detection and effective management of depression and cognitive impairment among individuals with diabetes has the potential to minimise adverse health outcomes. In order to promote screening healthcare professionals caring for individuals with diabetes in all settings must be aware of the increased risk of brain health complications in this vulnerable population.
The purpose of this paper has been to investigate the vulnerability of staff in an Irish district lunatic asylum (1869–1950) to infection and injury as exemplified by the records of Monaghan District Asylum (renamed Monaghan Mental Hospital in 1924 and St Davnet’s Hospital in 1954). Some comparisons with other Irish district asylums are included.
The Minutebooks of Monaghan District Asylum, located in St Davnet’s Complex, Monaghan, were sampled in December of each year from 1869 to 1950 with the sampling extended outwards as required. In addition, the reports on the District, Criminal and Lunatic Asylums in Ireland (1869–1921) and the annual reports of the Inspector of Mental Hospitals (1923–2013) were surveyed for comparisons.
Staff in Monaghan District Asylum were vulnerable to infection from contagious diseases including typhoid, tuberculosis and Spanish influenza. As with other Irish district asylums, overcrowding was the norm and isolation facilities were either absent or inadequate. The close proximity of staff to patients in an overcrowded and frequently insanitary institution placed them at increased risk of contracting disease. Moreover, staff at all levels, from resident medical superintendent to attendant, were, on occasion, at risk of injury from patients. The Monaghan experience would seem to indicate that any consideration of staff patient relationships within asylums should be nuanced by a consideration of the risks posed to staff due to their occupation.