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Environmental impacts of food systems have stimulated research to examine how to create healthy diets that will be more sustainable while meeting nutrient requirements. Increasing compliance with existing food-based dietary guidelines in most jurisdictions could be a first step to improve health and reduce environmental impact. MyPlanetDiet was an all-Ireland 12-week randomised controlled trial designed to inform sustainable healthy dietary guidelines. Healthy adults (n 355) aged 18–64 years with moderate-to-high greenhouse gas emitting (GHGE) diets were recruited from three study sites on the island of Ireland. The aim of this research is to assess the relationship between dietary intakes, diet-related environmental impacts and metabolic health using baseline data collected during the MyPlanetDiet study. Dietary assessments collected using Foodbook24 were used to calculate diet-related GHGE, adherence to healthy eating guidelines (HEG) and healthy eating index (HEI) score. Anthropometrics and metabolic health markers (e.g. lipids, glucose and insulin) were included. Overall HEG adherence was low, with 43 % meeting zero or one HEG food group recommendations. Adherence to 4 + HEG food group targets was associated with 31 % lower diet-related GHGE compared with those with lowest adherence. Higher HEG adherence was associated with lower BMI and waist circumference and higher HEI scores. While our findings suggest HEG adherence is associated with positive health and environmental impacts, substantial behaviour change will be needed to meet existing HEG. Further research is needed to assess response and acceptability to HEG. However, adherence to HEG may be an important first step to reducing the environmental impact of food consumption.
This abstract was presented as the Nutrition and Optimum Life Course Theme Highlight.
The n-3 polyunsaturated fatty acids (n-3 PUFA), eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3), are known for their beneficial roles in regulating inflammation(1). The omega 3 index (O3I) refers to the percentage of EPA+DHA within the erythrocyte membrane with respect to total fatty acids and is a recognised biomarker for cardiovascular disease(2). An O3I >8% is proposed to confer the greatest level of cardioprotection(2). Fish is the richest dietary source of n-3 PUFAs and has been noted as one of the main predictors of a higher O3I(3). Current UK dietary guidelines recommend the consumption of two portions of fish per week; albeit the efficacy of these recommendations in raising the O3I is unknown(4). The aim of this study was to investigate the influence of consuming two portions of fish per week on the O3I amongst low fish consuming women of childbearing age.
Data were analysed from the iFish study(5), an 8-week randomised controlled trial where low fish consuming women, were randomly assigned to consume either no fish (n = 18) or 2 portions of tuna (n = 8) or sardines (n = 9) per week. Total n-3 PUFA concentrations of the fish provided in the intervention were 6.47g/100g for sardines and 4.57g/100g for tuna. Fasting blood samples were collected at baseline and post-intervention. The O3I was determined in red blood cells in the control and two portions of fish groups by OmegaQuant Europe. Analysis of covariance, adjusting for age, BMI, and baseline O3I, examined the effect of the fish intervention on the O3I. Chi-square test was used to compare the O3I between groups when categorised as at risk (<4%), intermediate risk (48%) and low risk (>8%).
Participants had a mean ± SD age of 25.5 ± 6.4 years. Baseline median (IQR) O3I of the cohort was 5.7 (5.2, 6.7) %. There was no significant difference in the O3I between treatment groups at baseline. Consumption of two portions of fish significantly increased the O3I when compared to the consumption of no fish [6.73 (5.41, 7.38) % vs 5.58 (5.12, 6.49) %, respectively, p = 0.034]. Those consuming two portions of sardines, an oily fish high in n-3 PUFAs, had a significantly greater O3I when compared to those consuming two portions of tuna [7.38 (6.83, 8.37) % vs 5.61 (5.29, 6.79) %, respectively, p<0.001]. Post-intervention, the proportion of participants in the low risk O3I category (>8%) was greater in the two portions of fish group when compared to the control group; albeit this did not reach statistical significance (p = 0.104).
In support of the current dietary guidelines, increasing fish consumption of low consumers to two portions of any fish per week will increase the O3I. Future research should determine the potential cardioprotective properties of a higher O3I as a result of consuming fish.
Dietary intake can influence immune function indirectly by affecting the gut microbiota composition and metabolism(1). Fish consumption has been shown to positively regulate the gut microbiota in humans(2,3);albeit in those studies fish was consumed in high amounts (500-750g/week) and immune function was not investigated. This study investigated the effect of consuming the UK dietary recommendation for fish(4) (2 portions [140-280g/week], one of which is oily) on the gut microbiota alpha diversity. Further, we examined if changes (pre- to post-intervention) in the gut microbiota composition were associated with changes in immune cytokine concentrations.
An 8-week randomised controlled trial in low fish consuming women of childbearing age (n = 41; median age 23y) investigated the effect of consuming 1 or 2 portions of fish (tuna or sardines)/week compared to not consuming fish. A blood sample was collected to measure inflammatory cytokines (tumour necrosis factor-a, interleukin [IL]-1b, IL-5, IL-6, IL-17A and IL-22) pre-and post-intervention. Faecal samples were collected at both timepoints and extracted DNA was used to determine gut microbiota compositional profiles using 16S metagenomic sequencing (Illumina, USA). Statistical analysis investigated significant differences in changes in gut microbiota alpha diversity and compositional relative abundances between fish intervention (N = 26) and control (N = 15), then secondary analysis stratified by portion size (1 vs 2 portions) and type of fish (tuna vs sardines). Differences in cytokines between fish intervention and control were assessed by Mann-Whitney U. Spearman rank coefficient assessed associations between the changes in gut microbiota relative abundances with cytokine changes in fish and control groups.
Fish consumption increased gut microbiota alpha diversity indices (Chao1 [7.37±41.23], Simpson [0.003±0.163], Shannon [0.07±0.33], phylogenetic diversity [0.35±2.59], observed species [9.00±40.06]), albeit this was not significant compared to the control group (p>0.05). Consumption of fish, specifically sardines, for 8 weeks significantly reduced Bacteroidetes (-4.77±4.88%) when compared to control (+4.15±7.58%) (p<0.01). No significant differences were observed between the change in relative abundances of gut microbiota at genus-level taxa or inflammatory cytokines between the fish intervention and control. In the fish intervention group, increases in IL-17A, IL-22 and IL-6 concentrations were positively correlated with changes in Alistipes, Rhodococcus, Haemophilus, Barnesiella and Akkermansia relative abundances (p<0.05).
Although not statistically significant, consistent findings suggest that fish intake, in line with dietary guidelines, may have favourable impact on gut microbiota. Sardines, oily fish rich in n-3 polyunsaturated fatty acids, may have health benefits in disease states where Bacteroidetes is elevated; nevertheless, further research is required in a larger cohort over a longer period.
Converting measurements of ice-sheet surface elevation change to mass change requires measurements of accumulation and knowledge of the evolution of the density profile in the firn. Most firn-densification models are tuned using measured depth–density profiles, a method which is based on an assumption that the density profile in the firn is invariant through time. Here we present continuous measurements of firn-compaction rates in 12 boreholes near the South Pole over a 2 year period. To our knowledge, these are the first continuous measurements of firn compaction on the Antarctic plateau. We use the data to derive a new firn-densification algorithm framed as a constitutive relationship. We also compare our measurements to compaction rates predicted by several existing firn-densification models. Results indicate that an activation energy of 60 kJ mol−1, a value within the range used by current models, best predicts the seasonal cycle in compaction rates on the Antarctic plateau. Our results suggest models can predict firn-compaction rates with at best 7% uncertainty and cumulative firn compaction on a 2 year timescale with at best 8% uncertainty.
Maternal fish consumption exposes the fetus to beneficial nutrients and potentially adverse neurotoxicants. The current study investigated associations between maternal fish consumption and child neurodevelopmental outcomes. Maternal fish consumption was assessed in the Seychelles Child Development Study Nutrition Cohort 1 (n 229) using 4-day food diaries. Neurodevelopment was evaluated at 9 and 30 months, and 5 and 9 years with test batteries assessing twenty-six endpoints and covering multiple neurodevelopmental domains. Analyses used multiple linear regression with adjustment for covariates known to influence child neurodevelopment. This cohort consumed an average of 8 fish meals/week and the total fish intake during pregnancy was 106·8 (sd 61·9) g/d. Among the twenty-six endpoints evaluated in the primary analysis there was one beneficial association. Children whose mothers consumed larger quantities of fish performed marginally better on the Kaufman Brief Intelligence Test (a test of nonverbal intelligence) at age 5 years (β 0·003, 95 % CI (0, 0·005)). A secondary analysis dividing fish consumption into tertiles found no significant associations when comparing the highest and lowest consumption groups. In this cohort, where fish consumption is substantially higher than current global recommendations, maternal fish consumption during pregnancy was not beneficially or adversely associated with children’s neurodevelopmental outcomes.
The Hierarchical Taxonomy of Psychopathology (HiTOP) has emerged out of the quantitative approach to psychiatric nosology. This approach identifies psychopathology constructs based on patterns of co-variation among signs and symptoms. The initial HiTOP model, which was published in 2017, is based on a large literature that spans decades of research. HiTOP is a living model that undergoes revision as new data become available. Here we discuss advantages and practical considerations of using this system in psychiatric practice and research. We especially highlight limitations of HiTOP and ongoing efforts to address them. We describe differences and similarities between HiTOP and existing diagnostic systems. Next, we review the types of evidence that informed development of HiTOP, including populations in which it has been studied and data on its validity. The paper also describes how HiTOP can facilitate research on genetic and environmental causes of psychopathology as well as the search for neurobiologic mechanisms and novel treatments. Furthermore, we consider implications for public health programs and prevention of mental disorders. We also review data on clinical utility and illustrate clinical application of HiTOP. Importantly, the model is based on measures and practices that are already used widely in clinical settings. HiTOP offers a way to organize and formalize these techniques. This model already can contribute to progress in psychiatry and complement traditional nosologies. Moreover, HiTOP seeks to facilitate research on linkages between phenotypes and biological processes, which may enable construction of a system that encompasses both biomarkers and precise clinical description.
Inadequate sleep and poor eating behaviours are associated with higher risk of childhood overweight and obesity. Less is known about the influence sleep has on eating behaviours and consequently body composition. Furthermore, whether associations differ in boys and girls has not been investigated extensively. We investigate associations between sleep, eating behaviours and body composition in cross-sectional analysis of 5-year-old children. Weight, height, BMI, mid upper arm circumference (MUAC), abdominal circumference (AC) and skinfold measurements were obtained. Maternal reported information on child’s eating behaviour and sleep habits were collected using validated questionnaires. Multiple linear regression examined associations between sleep, eating behaviours and body composition. Sleep duration was negatively associated with BMI, with 1-h greater sleep duration associated with 0·24 kg/m2 (B = 0·24, CI −0·42, −0·03, P = 0·026) lower BMI and 0·21 cm lower (B = –0·21, CI −0·41, −0·02, P = 0·035) MUAC. When stratified by sex, girls showed stronger inverse associations between sleep duration (h) and BMI (kg/m2) (B = –0·32; CI −0·60, −0·04, P = 0·024), MUAC (cm) (B = –0·29; CI −0·58, 0·000, P = 0·05) and AC (cm) (B = –1·10; CI −1·85, −0·21, P = 0·014) than boys. Positive associations for ‘Enjoys Food’ and ‘Food Responsiveness’ with BMI, MUAC and AC were observed in girls only. Inverse associations between sleep duration and ‘Emotional Undereating’ and ‘Food Fussiness’ were observed in both sexes, although stronger in boys. Sleep duration did not mediate the relationship between eating behaviours and BMI. Further exploration is required to understand how sleep impacts eating behaviours and consequently body composition and how sex influences this relationship.
Pharmacogenomic testing has emerged to aid medication selection for patients with major depressive disorder (MDD) by identifying potential gene-drug interactions (GDI). Many pharmacogenomic tests are available with varying levels of supporting evidence, including direct-to-consumer and physician-ordered tests. We retrospectively evaluated the safety of using a physician-ordered combinatorial pharmacogenomic test (GeneSight) to guide medication selection for patients with MDD in a large, randomized, controlled trial (GUIDED).
Materials and Methods
Patients diagnosed with MDD who had an inadequate response to ≥1 psychotropic medication were randomized to treatment as usual (TAU) or combinatorial pharmacogenomic test-guided care (guided-care). All received combinatorial pharmacogenomic testing and medications were categorized by predicted GDI (no, moderate, or significant GDI). Patients and raters were blinded to study arm, and physicians were blinded to test results for patients in TAU, through week 8. Measures included adverse events (AEs, present/absent), worsening suicidal ideation (increase of ≥1 on the corresponding HAM-D17 question), or symptom worsening (HAM-D17 increase of ≥1). These measures were evaluated based on medication changes [add only, drop only, switch (add and drop), any, and none] and study arm, as well as baseline medication GDI.
Results
Most patients had a medication change between baseline and week 8 (938/1,166; 80.5%), including 269 (23.1%) who added only, 80 (6.9%) who dropped only, and 589 (50.5%) who switched medications. In the full cohort, changing medications resulted in an increased relative risk (RR) of experiencing AEs at both week 4 and 8 [RR 2.00 (95% CI 1.41–2.83) and RR 2.25 (95% CI 1.39–3.65), respectively]. This was true regardless of arm, with no significant difference observed between guided-care and TAU, though the RRs for guided-care were lower than for TAU. Medication change was not associated with increased suicidal ideation or symptom worsening, regardless of study arm or type of medication change. Special attention was focused on patients who entered the study taking medications identified by pharmacogenomic testing as likely having significant GDI; those who were only taking medications subject to no or moderate GDI at week 8 were significantly less likely to experience AEs than those who were still taking at least one medication subject to significant GDI (RR 0.39, 95% CI 0.15–0.99, p=0.048). No other significant differences in risk were observed at week 8.
Conclusion
These data indicate that patient safety in the combinatorial pharmacogenomic test-guided care arm was no worse than TAU in the GUIDED trial. Moreover, combinatorial pharmacogenomic-guided medication selection may reduce some safety concerns. Collectively, these data demonstrate that combinatorial pharmacogenomic testing can be adopted safely into clinical practice without risking symptom degradation among patients.
Optimal maternal long-chain PUFA (LCPUFA) status is essential for the developing fetus. The fatty acid desaturase (FADS) genes are involved in the endogenous synthesis of LCPUFA. The minor allele of various FADS SNP have been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of arachidonic acid (AA) and DHA. There is limited research on the influence of FADS genotype on cord PUFA status. The current study investigated the influence of maternal and child genetic variation in FADS genotype on cord blood PUFA status in a high fish-eating cohort. Cord blood samples (n 1088) collected from the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Of those with cord PUFA data available, maternal (n 1062) and child (n 916), FADS1 (rs174537 and rs174561), FADS2 (rs174575), and FADS1-FADS2 (rs3834458) were determined. Regression analysis determined that maternal minor allele homozygosity was associated with lower cord blood concentrations of DHA and the sum of EPA + DHA. Lower cord blood AA concentrations were observed in children who were minor allele homozygous for rs3834458 (β = 0·075; P = 0·037). Children who were minor allele carriers for rs174537, rs174561, rs174575 and rs3834458 had a lower cord blood AA:LA ratio (P < 0·05 for all). Both maternal and child FADS genotype were associated with cord LCPUFA concentrations, and therefore, the influence of FADS genotype was observed despite the high intake of preformed dietary LCPUFA from fish in this population.
Shortages of personal protective equipment during the coronavirus disease 2019 (COVID-19) pandemic have led to the extended use or reuse of single-use respirators and surgical masks by frontline healthcare workers. The evidence base underpinning such practices warrants examination.
Objectives:
To synthesize current guidance and systematic review evidence on extended use, reuse, or reprocessing of single-use surgical masks or filtering face-piece respirators.
Data sources:
We used the World Health Organization, the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and Public Health England websites to identify guidance. We used Medline, PubMed, Epistemonikos, Cochrane Database, and preprint servers for systematic reviews.
Methods:
Two reviewers conducted screening and data extraction. The quality of included systematic reviews was appraised using AMSTAR-2. Findings were narratively synthesized.
Results:
In total, 6 guidance documents were identified. Levels of detail and consistency across documents varied. They included 4 high-quality systematic reviews: 3 focused on reprocessing (decontamination) of N95 respirators and 1 focused on reprocessing of surgical masks. Vaporized hydrogen peroxide and ultraviolet germicidal irradiation were highlighted as the most promising reprocessing methods, but evidence on the relative efficacy and safety of different methods was limited. We found no well-established methods for reprocessing respirators at scale.
Conclusions:
Evidence on the impact of extended use and reuse of surgical masks and respirators is limited, and gaps and inconsistencies exist in current guidance. Where extended use or reuse is being practiced, healthcare organizations should ensure that policies and systems are in place to ensure these practices are carried out safely and in line with available guidance.
Optimal maternal polyunsaturated fatty acid (PUFA) status is essential for foetal development. The desaturase enzymes, encoded by the fatty acid desaturase (FADS) genes, are involved in the endogenous synthesis of long chain (LC)PUFA and influence maternal LCPUFA concentrations. The minor allele of various FADS SNPs has been associated with increased maternal concentrations of the precursors linoleic acid (LA) and α-linolenic acid (ALA), and lower concentrations of the LCPUFA arachidonic acid (AA) and docosahexaenoic acid (DHA); however, there is limited research to date on the influence of FADS genotype on cord PUFA status. The aim of the current study was to investigate the influence of maternal and child genetic variation on cord blood PUFA status in a high fish-eating cohort.
Cord blood samples collected from mother-child pairs (n = 1088) taking part in the Seychelles Child Development Study (SCDS) Nutrition Cohort 2 (NC2) were analysed for total serum PUFA. Maternal (n = 1088) and child genotype (n = 592) were determined for the FADS SNPs rs174537, rs174561, rs174575, and rs3834458. Regression analysis determined associations between maternal and child FADS genotype and cord PUFA status. In all regression models, the major allele homozygote genotype for each SNP was used as the reference group.
Directions of significant associations were as predicted. In mothers, the minor allele homozygote genotype for SNPs rs174537, rs174561 and rs3834458 was associated with lower cord DHA and lower total n-3 PUFA when compared to the major allele homozygous genotype (p < 0.05 for all). The heterozygous genotype was associated with increased concentrations of LA compared to the reference genotype for rs174561 (p = 0.021) and rs383448 (p = 0.023). In children, the heterozygous genotype was associated with lower AA concentrations and lower cord n-6:n-3 ratio for all SNPs (p < 0.05 for all) compared to those with the major allele homozygous genotype. A lower cord AA:LA ratio was also observed for children heterozygous for rs174547, rs174561 and rs174575 (p < 0.05 for all). Contrary to expected, there were no associations between cord PUFA concentrations and child minor allele homozygous genotype.
The current study indicates that variation in maternal and child FADS genotype influences cord PUFA concentrations, despite the high intake of preformed dietary LCPUFA from fish in this population. The sample size for minor allele homozygous children was likely too small to observe any statistically significant associations in the current analysis. Further research is needed to determine whether increased dietary intake can compensate for lower PUFA status as a result of FADS genotype.
Categorical rubrics are the prevailing approach to personality disorder (PD) assessment and diagnosis. Diagnostic manuals, funding bodies, and training programs tend to follow this categorical model. Yet there is now abundant evidence that PD categories are impeding research progress on personality pathology. This chapter describes an emerging dimensional perspective on personality problems, the Hierarchical Taxonomy of Psychopathology (HiTOP). The HiTOP framework encapsulates factor analytically derived higher- and lower-order dimensions of personality pathology, ranging from an overarching general factor of psychopathology at the hierarchy’s apex to homogeneous maladaptive personality traits and acute symptoms at the base. This multi-level system bypasses aspects of categorical PD diagnoses that researchers find problematic (e.g., comorbidity, within-diagnosis heterogeneity, and insufficient coverage of personality problems encountered in the clinic). HiTOP has the potential to renew field-wide interest in PD and streamline social, psychological, and biological research on personality pathology.
The Genomics Used to Improve DEpresssion Decisions (GUIDED) trial assessed outcomes associated with combinatorial pharmacogenomic (PGx) testing in patients with major depressive disorder (MDD). Analyses used the 17-item Hamilton Depression (HAM-D17) rating scale; however, studies demonstrate that the abbreviated, core depression symptom-focused, HAM-D6 rating scale may have greater sensitivity toward detecting differences between treatment and placebo. However, the sensitivity of HAM-D6 has not been tested for two active treatment arms. Here, we evaluated the sensitivity of the HAM-D6 scale, relative to the HAM-D17 scale, when assessing outcomes for actively treated patients in the GUIDED trial.
Methods:
Outpatients (N=1,298) diagnosed with MDD and an inadequate treatment response to >1 psychotropic medication were randomized into treatment as usual (TAU) or combinatorial PGx-guided (guided-care) arms. Combinatorial PGx testing was performed on all patients, though test reports were only available to the guided-care arm. All patients and raters were blinded to study arm until after week 8. Medications on the combinatorial PGx test report were categorized based on the level of predicted gene-drug interactions: ‘use as directed’, ‘moderate gene-drug interactions’, or ‘significant gene-drug interactions.’ Patient outcomes were assessed by arm at week 8 using HAM-D6 and HAM-D17 rating scales, including symptom improvement (percent change in scale), response (≥50% decrease in scale), and remission (HAM-D6 ≤4 and HAM-D17 ≤7).
Results:
At week 8, the guided-care arm demonstrated statistically significant symptom improvement over TAU using HAM-D6 scale (Δ=4.4%, p=0.023), but not using the HAM-D17 scale (Δ=3.2%, p=0.069). The response rate increased significantly for guided-care compared with TAU using both HAM-D6 (Δ=7.0%, p=0.004) and HAM-D17 (Δ=6.3%, p=0.007). Remission rates were also significantly greater for guided-care versus TAU using both scales (HAM-D6 Δ=4.6%, p=0.031; HAM-D17 Δ=5.5%, p=0.005). Patients taking medication(s) predicted to have gene-drug interactions at baseline showed further increased benefit over TAU at week 8 using HAM-D6 for symptom improvement (Δ=7.3%, p=0.004) response (Δ=10.0%, p=0.001) and remission (Δ=7.9%, p=0.005). Comparatively, the magnitude of the differences in outcomes between arms at week 8 was lower using HAM-D17 (symptom improvement Δ=5.0%, p=0.029; response Δ=8.0%, p=0.008; remission Δ=7.5%, p=0.003).
Conclusions:
Combinatorial PGx-guided care achieved significantly better patient outcomes compared with TAU when assessed using the HAM-D6 scale. These findings suggest that the HAM-D6 scale is better suited than is the HAM-D17 for evaluating change in randomized, controlled trials comparing active treatment arms.
The study aims to explore the views of consultant psychiatrists in Ireland on shared care between specialist psychiatric services and primary care.
Methods
A self-administered questionnaire was posted to all 470 consultant psychiatrists working in Ireland. Self addressed envelopes were included for the return of completed questionnaires. Data was analysed using descriptive statistics and ANOVA
Results
213 questionnaires were returned giving a response rate of 45%. 47.9% of the respondents were male and 52.1% were female. Over all, 91% of respondents reported that they would support a general policy on shared care between primary care and specialised psychiatric services for patients who are stable on their treatment. However, 85% reported that they foresaw difficulties for patients in implementing such a policy, including: increased financial burden on some patients (66%), lack of adequate allied health professionals resources in primary care (60%) and GP's not adequately trained to provide psychiatric care (52%). Most psychiatrists did not feel comfortable to transfer the care of patients with schizophrenia or bipolar disorder to their GP's and Child psychiatrists were significantly less comfortable than other psychiatrists to discharge patients with Depression, Bipolar Disorder, Anxiety Disorder, Alcohol Dependency Syndrome and Personality Disorder into the care of GP's after they have been stabilised in their medication.
Conclusion
Although most psychiatrists in Ireland would support a policy of shared care, they identify several constraints which would currently hamper the effective implementation of a policy of active collaboration between primary care and specialised psychiatric services in Ireland.
The study aims to explore the views of primary care physicians in Ireland on shared care of psychiatric patients between primary and secondary services.
Methods
A self-administered questionnaire was posted to a random cross-section primary care physicians working in Ireland. Data were compiled and analyzed using descriptive statistics and analysis of variance.
Results
145 out of 300 questionnaires were returned giving a response rate of 48%. Overall, 77.9% of respondents reported that they completed a psychiatric rotation as part of their general practice training. Most General Practitioners expressed confidence in their ability to recognize and manage psychiatric disorders in primary care (on a confidence scale of 1 to 5, mean was 3.97, SD 0.699). There was a statistically, significant difference in confidence scores between those who had took a rotation in psychiatry as part of their GP training and those who did not, with the former reporting higher scores (4.04 vs. 3.72, F = 1.801, t = 2.363, p = 0.02)Regarding shared care, 95.8% of GPs were in favour of a formal shared care policy; however 42.8% expressed reservations regarding the implications of implementing such a policy. The most frequently expressed concerns related to the lack of resources in primary care for psychiatric patients (55.9%), financial implications for some patients (48.3%), and concern over communication with psychiatric services (42%).
Conclusion
The majority of Primary Care physicians in Ireland would support a policy of shared care of psychiatric patients’; however they raise some concerns regarding practical implications of such a policy.
Diagnosis and classification for mental disorder are in flux. This transition has downstream consequences on the nature of clinical assessment in research and treatment settings. We begin this chapter by describing the prevailing categorical rubrics, which are the predominant guide to clinical assessment worldwide. These systems, despite their popularity, suffer from serious defects, which have prompted the development of alternate frameworks for conceptualization and assessment of psychopathology. We focus the remainder of the chapter on two prominent contenders to supplement, and perhaps eventually supplant, traditional categorical models. The Hierarchical Taxonomy of Psychopathology is an empirically derived system of the phenotypic dimensions of psychopathology and the Research Domain Criteria represent a biologically oriented approach to understanding risk processes implicated in mental disorder. We describe the promise and challenges facing these two emerging systems, and we speculate about how they will shape the future of clinical assessment.