We aim to describe the psychosocial features, including Stanford Integrated Psychosocial Assessment for transplantation (SIPAT) scores of individuals undergoing assessment for heart transplantation in Ireland.

All potential heart transplant candidates undergo assessment of psychosocial criteria to enhance selection and improve transplant outcomes. The Mater Hospital Consultation Liaison Psychiatry (CLP) department provides this national service in Ireland. All potential heart transplant candidates should receive a biopsychosocial assessment and screening via SIPAT tool as per international best practice. The SIPAT is a psychosocial evaluation and risk assessment tool which can help to determine suitability for organ transplant and identify modifiable risk factors to optimise a patient for transplant. Lower scores represent higher rates of suitability with a score < 21 representing an acceptable candidate and ≥21 minimally acceptable.

We retrospectively examined the clinical files of all individuals referred to the national centre for heart transplant assessment over a five-year study period between January 2014 and December 2019.

One-hundred and fifty four individuals were referred for heart transplant assessment with 79% (n=122/154) listed for a heart transplant. The most common indication for heart transplant assessment was non-ischaemic cardiomyopathy (48%, n=74/154). Of those listed for transplant, 74% (n=90/122) went on to receive a heart transplant. Of those undergoing assessment for heart transplant, 92% (142/154) were assessed by CLP and 94% (144/154) received social work assessment.

SIPAT scores were available for 64/154 individuals with 22% (14/64) deemed excellent candidates for transplant, 59% (38/64) deemed good candidates, 14% (9/64) minimally acceptable candidate and 5% (3/64) deemed high risk. The SIPAT domain breakdown was as follows: patient readiness (mean 3.9, SD 3.4); social support system (mean 2.9, SD 4.2); psychological stability (mean 5.1, SD 4.9); and substance use (mean 3.8, SD2.4), with an average total score of 16 (SD 12.4).

Post-transplant, 26% (23/90) were referred and seen by CLP, 53% (48/90) were referred to social work and 32% (29/90) required psychology services. Seventeen individuals (19%, 17/90) received a psychiatric diagnosis and 27% (24/90) were prescribed psychotropic medication in the post-transplant period.

This study describes for the first time the psychosocial factors and SIPAT scores of a national cohort of individuals referred for heart transplant. Psychiatric morbidity is high and this has implication for transplant suitability and post-operative course. This highlights the need for services to proactively identify and treat psychosocial factors in potential transplant recipients.

None Declared

As part of the Research Domain Criteria (RDoC) initiative, the NIMH seeks to improve experimental measures of cognitive and positive valence systems for use in intervention research. However, many RDoC tasks have not been psychometrically evaluated as a battery of measures. Our aim was to examine the factor structure of 7 such tasks chosen for their relevance to schizophrenia and other forms of serious mental illness. These include the n-back, Sternberg, and self-ordered pointing tasks (measures of the RDoC cognitive systems working memory construct); flanker and continuous performance tasks (measures of the RDoC cognitive systems cognitive control construct); and probabilistic learning and effort expenditure for reward tasks (measures of reward learning and reward valuation constructs).

The sample comprised 286 cognitively healthy participants who completed novel versions of all 7 tasks via an online recruitment platform, Prolific, in the summer of 2022. The mean age of participants was 38.6 years (SD = 14.5, range 18-74), 52% identified as female, and stratified recruitment ensured an ethnoracially diverse sample. Excluding time for instructions and practice, each task lasted approximately 6 minutes. Task order was randomized. We estimated optimal scores from each task including signal detection d-prime measures for the n-back, Sternberg, and continuous performance task, mean accuracy for the flanker task, win-stay to win-shift ratio for the probabilistic learning task, and trials completed for the effort expenditure for reward task. We used parallel analysis and a scree plot to determine the number of latent factors measured by the 7 task scores. Exploratory factor analysis with oblimin (oblique) rotation was used to examine the factor loading matrix.

The scree plot and parallel analyses of the 7 task scores suggested three primary factors. The flanker and continuous performance task both strongly loaded onto the first factor, suggesting that these measures are strong indicators of cognitive control. The n-back, Sternberg, and self-ordered pointing tasks strongly loaded onto the second factor, suggesting that these measures are strong indicators of working memory. The probabilistic learning task solely loaded onto the third factor, suggesting that it is an independent indicator of reinforcement learning. Finally, the effort expenditure for reward task modestly loaded onto the second but not the first and third factors, suggesting that effort is most strongly related to working memory.

Our aim was to examine the factor structure of 7 RDoC tasks. Results support the RDoC suggestion of independent cognitive control, working memory, and reinforcement learning. However, effort is a factorially complex construct that is not uniquely or even most strongly related to positive valance. Thus, there is reason to believe that the use of at least 6 of these tasks are appropriate measures of constructs such as working memory, reinforcement learning and cognitive control.

Cognitive deficits in patients diagnosed with schizophrenia are a core feature of the disorder. There are currently no treatments for these cognitive deficits. Our aim was to examine and compare patterns of increased versus decreased activity in the central executive network (CEN), salience network (SN), and default mode network (DMN) between healthy controls (HCs) and patients diagnosed with schizophrenia (SZs) as well as to explore the influence of task load on these networks between HCs and SZs.

Analyses focused on a secondary dataset comprising Blood Oxygen-Level Dependent (BOLD) data collected from 25 HCs and 27 SZs who completed a working memory (WM) task (N-back) with 5 load conditions while undergoing functional magnetic resonance imaging (fMRI). Region of interest (ROI) data were analyzed using linear mixed-effects models.

Group activation differences were found in the posterior salience network (pSN), default mode network (DMN), dorsal default mode network (dDMN), and ventral default mode network (vDMN) showing greater activity for SZs. Specifically, pSN, DMN, dDMN, and vDMN all showed increased activity in SZs compared to HCs. The curve of brain activity was consistent between HCs and SZs with the exception of the vDMN, where HCs show greater activation at modest mental workload (quadratic curve) and SZs showed greater brain activation at lower mental workload (linear). In the CEN, there were no group differences, and the response curve was the same for both groups.

These group differences demonstrate network difference between HCs and SZs and could show value in treatments targeting cognitive deficits in SZs from a large-scale brain network connectivity perspective. Future studies are needed to confirm these results with larger sample size in order to examine potential subtleties of interactions between these networks.

Agricultural workers are immersed in environments associated with increased risk for adverse psychiatric and neurological outcomes. Agricultural work-related risks to brain health include exposure to pesticides, heavy metals, and organic dust. Despite this, there is a gap in our understanding of the underlying brain systems impacted by these risks. This study explores clinical and cognitive domains, and functional brain activity in agricultural workers. We hypothesized that a history of agricultural work-related risks would be associated with poorer clinical and cognitive outcomes as well as changes in functional brain activity within cortico-striatal regions.

The sample comprised 17 agricultural workers and a comparison group of 45 non-agricultural workers recruited in the Northern Colorado area. All participants identified as White and non-Hispanic. The mean age of participants was 51.7 years (SD = 21.4, range 18-77), 60% identified as female, and 37% identified as male. Participants completed the National Institute of Health Toolbox (NIH Toolbox) and Montreal Cognitive Assessment (MoCA) on their first visit. During the second visit, they completed NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measures and underwent functional magnetic resonance imaging (fMRI; N = 15 agriculture and N = 35 non-agriculture) while completing a working memory task (Sternberg). Blood oxygen-level dependent (BOLD) response was compared between participants. Given the small sample size, the whole brain voxel-wise group comparison threshold was set at alpha = .05, but not otherwise corrected for multiple comparisons. Cohen’s d effect sizes were estimated for all voxels.

Analyses of cognitive scores showed significant deficits in episodic memory for the agricultural work group. Additionally, the agricultural work group scored higher on measures of self-reported anger, cognitive concerns, and social participation. Analyses of fMRI data showed increased BOLD activity around the orbitofrontal cortex (medium to large effects) and bilaterally in the entorhinal cortex (large effects) for the agricultural work group. The agricultural work group also showed decreased BOLD activity in the cerebellum and basal ganglia (medium to large effects).

To our knowledge, this study provides the first-ever evidence showing differences in brain activity associated with a history of working in agriculture. These findings of poorer memory, concerns about cognitive functioning, and increased anger suggest clinical relevance. Social participation associated with agricultural work should be explored as a potential protective factor for cognition and brain health. Brain imaging data analyses showed increased activation in areas associated with motor functioning, cognitive control, and emotion. These findings are limited by small sample size, lack of diversity in our sample, and coarsely defined risk. Despite these limitations, the results are consistent with an overall concern that risks associated with agricultural work can lead to cognitive and psychiatric harm via changes in brain health. Replications and future studies with larger sample sizes, more diverse participants, and more accurately defined risks (e.g., pesticide exposure) are needed.

Deficits in cognitive ability are common among patients with schizophrenia. The MATRICS Consensus Cognitive Battery (MCCB) was designed to assess cognitive ability in studies of patients diagnosed with schizophrenia and has demonstrated high test-retest reliability with minimal practice effects, even in multi-site trials. However, given the motivational challenges associated with schizophrenia, it is unknown whether performance on MCCB tasks affects performance at later stages of testing. The goal of this study was to determine whether there are differences between people with and without schizophrenia in how their performance on individual MCCB tasks influences their performance throughout the battery.

The sample comprised 92 total participants including 49 cognitively healthy comparison participants and 43 outpatients diagnosed with schizophrenia. The mean age of participants was 44.2 years (SD = 12.0, range 21–69) and 61% identified as male. The Trail Making Test, Brief Assessment of Cognition in Schizophrenia, Hopkins Verbal Learning Test – Revised, Letter-Number Span, and Category Fluency from the MCCB were administered in the same order at 2 different sites and studies from 2016–2022. The autocorrelation between t-scores for task scores within each participant was computed and then compared between control and outpatient participants to determine if there are differences between groups. Group mean t-scores for each task were also compared between groups.

We found no significant difference in autocorrelations across MCCB tasks between healthy comparison participants and outpatients. However, mean performance in all tasks was lower for the outpatient group than for the healthy comparison group. None of the tasks used stood out as having significantly lower mean scores than other tasks for either group.

Our findings suggest that performance on individual MCCB tasks do not affect performance throughout the battery differently between the healthy comparison group and outpatients. This suggests that participants with schizophrenia are not particularly reactive to past performance on MCCB tasks. Additionally, this finding further supports use of the MCCB in this population. Further research is needed to determine whether subgroups of patients and/or different batteries of measures show different patterns of reactivity.

Mental health difficulties are often exacerbated during the perinatal period. Policy and guidelines are increasingly being used to enhance the quality of healthcare. We conducted a literature review of published research relating to pregnancy and breastfeeding in mental health policy.

Relevant terms were searched in Medline, CINAHL, APA PsycINFO and EMBASE for articles published in English from 1970 until 2020. Only papers that referenced policy, guidance, legislation or standards were included. While a systematic approach was used, the nature of the results necessitated a narrative review.

Initially, 262 papers were identified, 44 met the inclusion criteria. Reproductive health is given sparse consideration in research relating to mental health policy. Despite this, some key areas emerged. These included: the need for proactive preconception psychoeducation, proactive screening of mothers of infants and young children for perinatal mental health issues, enhanced prescribing practice for women of child-bearing age, enhanced monitoring during pregnancy, development of safe modification of coercive practices should they need to be employed in emergency circumstances and targeted measures to reduce substance misuse. Themes that arose relating to breastfeeding and bonding are also described.

Female reproductive health is often ignored in research relating to mental health policy, guidelines and standards. These tools need to be harnessed to promote good healthcare. Reproductive health should be included in the care plan of all mental health patients. These topics need to be integrated into existing relevant policies and not isolated to a separate policy.

International guidelines recommend that prospective organ transplant patients receive a psychosocial assessment to optimise outcomes. There is limited consensus regarding the criteria for psychosocial evaluation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) tool was developed to enhance the pre-transplant psychosocial workup. The Mater Hospital is the National Centre for heart and lung transplantation in Ireland. The consultation-liaison psychiatry (CLP) service provides screening of pre-transplant candidates using a biopsychosocial assessment, SIPAT and cognitive screening tools. Post-transplant patients are reviewed on a referral basis.

To identify the psychosocial needs of heart and lung transplant recipients and CLP service input over a one year period.

A review of all heart and lung transplant recipients between January 1st and December 31st 2021 was conducted. The following data were recorded: demographics, pre-existing mental illness, SIPAT scores, and referral to the CLP service within six months of transplantation.

Twenty-eight individuals received a heart/lung transplant in 2021 (7 heart, 19 lung, 1 heart &liver, 1 heart & lung). Prior to transplant 50% (14/28) had a pre-existing mental health diagnosis, 7% (2/28) had attended a psychiatrist, and 28.6% (8/28) were on psychotropic medication. SIPAT scores were available for 20 patients. The overall mean SIPAT score was 10.8 (SD 6.1). The subscales were as follows: Patient Readiness, mean 3.2 (SD 1.7); Social Support System, mean 2.1 (SD: 1.8); Psychological Stability & Psychopathology, mean 1.6 (SD 2.7); and Lifestyle & Substance Misuse, mean 3 (SD 1.5). Based on SIPAT scores, 20% (4/20) were excellent candidates, 75% (15/20) were good candidates and 1 (1/20) was minimally acceptable. Pre-existing mental illness was associated with higher total SIPAT scores (p=0.013) and higher scores on the psychological stability subscale (p=0.032). Post-transplant, 50% (14/28) were referred for psychological support and 21.4% (6/28) were referred to the CLP service. A further 10.7% (n=3) were attending CLP prior to transplant. Referrals to CLP occurred (median) 13 days (range 1-275) post-transplant surgery. The reasons for attending CLP were anxiety (5/9), delirium (3/9) and mood (1/9).

SIPAT can be a valuable tool for use in the pre-transplant workup to help identify those that will require intensive psychosocial support post- transplant.

None Declared

Fifteen percent of women worldwide experience depression in the perinatal period. Suicide is now one of the leading causes of maternal mortality in developed countries. Internationally, many healthcare systems screen post-natal women for depressive symptoms and suicidal ideation to facilitate early assessment and intervention. To our knowledge, no Irish data exists on the prevalence of suicidal ideation in this cohort.

To evaluate the prevalence of suicidal ideation and depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) in post-natal women attending a large Dublin maternity hospital.

A retrospective cohort study was conducted. Women were randomly selected by delivery date over a 6 month period. Demographic and medical information was collected from their booking visit and discharge summary data. EPDS results at discharge post-partum were examined.

Data was collected on 643 women. Post-partum, 19 women (3.4%) had experienced suicidal ideation in the previous 7 days. Just over half of these women also had high EPDS scores (>12). Overall, 29 women (5.2%) screened positive for depression (EPDS score > 12).

The rate of suicidal ideation is in line with the published international data and emphasises the need for all clinicians to inquire about such thoughts. Training of midwifery and obstetric staff is required. Maternity units should have a policy on the management of suicidal ideation and risk. The prevalence of depressive symptoms post-partum was comparatively low in our study. This could suggest that antenatal screening and early intervention, which are integral parts of the perinatal mental health service, are effective. However, due to limitations of the study, it could also reflect an under-representation of depressive symptom burden in this cohort.

To outline characteristics of patients with anxiety diagnoses attending a Specialist Perinatal Mental Health Service (SPMHS) in Ireland, the mental health care received by those patients, mental health and obstetric outcomes for those patients, and immediate neonatal outcomes for their babies.

A retrospective chart review was conducted of patients with antenatal anxiety diagnoses who attended the SPMHS in University Maternity Hospital Limerick, from initiation of the service to the end of its first year.

Data were collected on 100 patients, 81 with a mental health diagnosis prior to attending the SPMHS, 32 with prior engagement with psychiatry, and 23 with a previous perinatal diagnosis. The mean age of patients was 32.4 (19–47, std 6.158). Beyond initial assessment, the Mental Health Midwife was involved in the care of 61% of patients, more than any other specialty including psychiatry. Twenty-seven patients had psychiatric medication either started or altered by the SPMHS. The most common reason for eventual discharge was that patients were well. Two patients presented in mental-health-related crisis to emergency services and one patient was admitted to an acute psychiatric ward.

Patients attending the SPMHS for anxiety spanned a broad spectrum of demographics and diagnoses and received varied set of interventions. A significant proportion of patients had a primary diagnosis of Pregnancy-related anxiety. The Mental Health Midwife played a key role in management of these patients. Though rates of mental health crises and admissions were low, the absence of a Mother and Baby Unit in Ireland was highlighted.

Dual diagnosis is commonly treated by Community Mental Health Team (CMHT). Addiction is a common complicating factor in individuals with major mental illnesses. It is established that businesses on high streets impact on the public’s health.

We hope to generate discussion about the planning and the placement of community mental health services.

The location of County Dublin community mental health teams’ outpatient clinics’ and day hospitals’ were obtained from the Health Service Executive directory website. All off licenses’ and bookmakers’ addresses in County Dublin were obtained from the Irish Revenue Commissioners website. The distances were measured using Google Maps and a programming script to generate a matrix under one-kilometre radius walking distances between the locations. No ethical approval is required. All Data are sought from publicly available websites.

On average, there are 6.29 (SD 4.20; Median 5.) off-licenses and 2.4 (SD 2.28; Median 2) bookmarkers offices per mental health facility within1 km walking distance. The Central Dublin Mental Health Service has the highest prevalence of off-licenses (45, 34.4%), and the Central South Dublin Service(20, 39.2%) has the highest prevalence of bookmakers. Southeast Dublin Service has the lowest in both businesses. The closest distance to an off-license from mental health facilities was 0 meters.

Psychiatrists have a role in advocating the needs of individuals with dual diagnoses. The Department of Health and Health Service Executive (HSE) should develop a guideline and protocol for the community health services in the structuring and planning mental health services in the community health outpatient service setup.

No significant relationships.

To characterize and compare the neuropsychological profiles of patients with primary progressive apraxia of speech (PPAOS) and apraxia of speech with progressive agrammatic aphasia (AOS-PAA).

Thirty-nine patients with PPAOS and 49 patients with AOS-PAA underwent formal neurological, speech, language, and neuropsychological evaluations. Cognitive domains assessed included immediate and delayed episodic memory (Wechsler Memory Scale-Third edition; Logical Memory; Visual Reproduction; Rey Auditory Verbal Learning Test), processing speed (Trail Making Test A), executive functioning (Trail Making Test B; Delis-Kaplan Executive Functioning Scale – Sorting), and visuospatial ability (Rey-Osterrieth Complex Figure copy).

The PPAOS patients were cognitively average or higher in the domains of immediate and delayed episodic memory, processing speed, executive functioning, and visuospatial ability. Patients with AOS-PAA performed more poorly on tests of immediate and delayed episodic memory and executive functioning compared to those with PPAOS. For every 1 unit increase in aphasia severity (e.g. mild to moderate), performance declined by 1/3 to 1/2 a standard deviation depending on cognitive domain. The degree of decline was stronger within the more verbally mediated domains, but was also notable in less verbally mediated domains.

The study provides neuropsychological evidence further supporting the distinction of PPAOS from primary progressive aphasia and should be used to inform future diagnostic criteria. More immediately, it informs prognostication and treatment planning.

Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings.

A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics.

A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84–0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85–0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52–0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55–0.79).

In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Cognitive tasks are used to probe neuronal activity during functional magnetic resonance imaging (fMRI) to detect signs of aberrant cognitive functioning in patients diagnosed with schizophrenia (SZ). However, nonlinear (inverted-U-shaped) associations between neuronal activity and task difficulty can lead to misinterpretation of group differences between patients and healthy comparison subjects (HCs). In this paper, we evaluated a novel method for correcting these misinterpretations based on conditional performance analysis.

Participants included 25 HCs and 27 SZs who performed a working memory (WM) task (N-back) with 5 load conditions while undergoing fMRI. Neuronal activity was regressed onto: 1) task load (i.e., parametric task levels), 2) marginal task performance (i.e., performance averaged over all load conditions), or 3) conditional task performance (i.e., performance within each load condition).

In most regions of interest, conditional performance analysis uniquely revealed inverted-U-shaped neuronal activity in both SZs and HCs. After accounting for conditional performance differences between groups, we observed few difference in both the pattern and level of neuronal activity between SZs and HCs within regions that are classically associated with WM functioning (e.g., posterior dorsolateral prefrontal and parietal association cortices). However, SZs did show aberrant activity within the anterior dorsolateral prefrontal cortex.

Interpretations of differences in neuronal activity between groups, and of associations between neuronal activity and performance, should be considered within the context of task performance. Whether conditional performance-based differences reflect compensation, dedifferentiation, or other processes is not a question that is easily resolved by examining activation and performance data alone.