To evaluate factors associated with positive LTBI screening among HCWs and predictors of treatment initiation and completion across hospital sites in Ireland.

Multicentre retrospective cohort study.

Five hospital sites in Ireland.

N = 755 healthcare workers (HCWs).

Evaluation of latent tuberculosis infection (LTBI) by interferon gamma release assay in HCWs from high-incidence countries during 2023, identified via occupational health records. IGRA positivity rates, linkage to treatment and treatment outcomes were recorded. Demographic and occupational factors associated with these outcomes were investigated.

There were n = 755 HCWs from high-incidence TB countries identified via occupational health records eligible for LTBI screening. 719 underwent IGRA testing, of whom 93 (13%) were positive. Age > 50 was associated with IGRA positivity (OR 5.71; 95% CI 1.79–18.17; P = .003). In addition to these n = 93 HCWs, two additional sites provided treatment outcomes for n = 164 HCWs, and a further n = 58 IGRA-positive HCWs were referred to Site 1. Among these 313 IGRA-positive HCWs, 50% initiated therapy, with substantial variation across sites (27%–88%). Multivariable analysis showed study site, but not demographic factors, predicted treatment initiation (P < .001). Common reasons for non-initiation included treatment refusal and non-attendance. Treatment completion was high (82%) and was not associated with study site.

LTBI prevalence among HCWs in Ireland was lower than international estimates. While treatment initiation was low, completion was high. Treatment initiation varied by site, driven by institutional rather than individual factors. A standardised national programmatic approach is needed for HCWs within the LTBI cascade of care.

Aggression and violence are common in psychiatric in-patient wards. Preventive measures such as de-escalation, increased observations, extra medication, restraint and seclusion are utilised by nurses and authorised by doctors in a highly skilled way that should be proportionate to the risks posed. There is limited empirical data on the proportionality of the use of restrictive practices within Irish forensic psychiatric units.

The aim of this study was to rate the severity of incidents and proportionality of response to incidents in the high secure unit within the National Forensic Mental Health Service.

This is a prospective cohort study set in the Central Mental Hospital. Patients were assessed each day using the Dynamic Assessment of Situational Aggression (DASA) scale and incidents were rated each day using the DUNDRUM Restriction-Intrusion of Liberty Ladders Scales (DRILL), which includes the assessment of adverse incidents, violence and self-harm, interventions including restrictive practices and consequences. In this study we used episodes of restriction as an outcome measure. Data were gathered as part of the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST). Generalised Estimating Equations were used to analyse repeated measures in the same subjects.

There were 384 patient days in scope, 411 lines of data including 326 patient-days, 85 incidents and 63 incidents of seclusion. The DRILL scales had good internal consistency (DRILL behaviours scale Cronbach’s alpha=0.789; DRILL interventions scale Alpha=0.866). The DASA on the day before an incident predicted the score on the DRILL behaviours scale (severity of behaviours) Wald X2=39565.2, p<0.001, with DUNDRUM-1 triage security scale also contributing significantly to the model Wald X2=884.3, p<0.001. The best model to predict the DRILL interventions scale included DASA on the day before (Wald X2=14.6, p=0.012) DRILL-behaviours scale (Wald X2=728.7, p<0.001) and DUNDRUM-1 (Wald X2=10,819.4, p<0.001). This was also the best model to predict whether or not a patient was secluded (DASA day before Wald X2=46.4, p<0.001; DRILL-behaviours scale Wald X2=173.2, p<0.001; DUNDRUM-1 Wald X2=6153.5, p<0.001).

Harmful behaviours and preventive and restrictive interventions can be described by rating items (‘ladders’) with good internal consistency, demonstrating that behaviour escalates in a meaningful sequence of increasingly serious harmful occurrences. The more serious the incident, the higher the level of restrictive practice used, demonstrating proportionality. This model of short term risk assessment and preventative interventions can be used to develop more effective and less restrictive interventions. Future research will explore moderating and mediating factors.

None Declared

Feigning is defined as “to represent falsely; to imitate so as to deceive” (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). Malingering and dissimulation are subtypes of feigning: malingering involves intentionally producing symptoms for incentives (World Health Organization. ICD-11 2022), while dissimulation involves concealing symptoms to appear mentally well (Caruso et al. J Am Acad Psychiatry Law 2003; 31:444-50). The prevalence of feigning illness remains uncertain, and varies with context and incentives. Within the legal context, 17.5% feign incompetence to stand trial and 64.5% to plead not guilty by reason of insanity. Malingering has been reported in up to 56% of general offender samples (McDermott et al. Int J Law Psychiatry 2013; 36:287-92). In the public setting, the malingering prevalence constituted 30% of disability evaluations, 29% of personal injury evaluations, 19% of criminal evaluations and 8% of medical cases (Mittenberg et al. J Clin Exp Neuropsychol). In 2006, malingering resulted in approximately $150 billion in annual expenses for the US insurance industry (Mason et al. Perspect Psychiatr Care 2014; 50: 51-7).

To explore the challenges in differentiating psychiatric illness from feigning.

This case involves analysing the patient’s history, collateral information, and diagnostic interviews to distinguish psychiatric pathology from feigned symptoms.

A 31-year-old male with a history of paranoid schizophrenia, whose recent psychiatric admission was prompted by psychosis and charges of serious assault, property damage, and possession of a weapon. The admission raised suspicions of symptom feigning and patient wariness of the psychiatric stigma. Despite four years of engagement with mental health services (MHS), the patient disclosed shortly after admission that he had been feigning his symptoms to obtain an insanity plea, but now hopes to return to prison seeking a more favourable environment and the certainty of a confirmed guilty sentence. Collateral information from the community MHS and family members suggested underlying psychiatric concerns and manipulative tendencies of the patient, complicating the diagnosis and raising the possibility of dissimulation.

The case highlights the challenges of distinguishing genuine psychiatric illness from deceptive behaviour, emphasizing the importance of thorough history-taking, understanding symptom pathology, using diverse interview techniques, gathering collateral information, and conducting psychological assessments. Clinicians must carefully distinguish feigning from true pathology to provide accurate diagnoses, ensure proper treatment, reduce costs, and safeguard public safety.

None Declared

Research implicates inflammation in the vicious cycle between depression and obesity, yet few longitudinal studies exist. The rapid weight loss induced by bariatric surgery is known to improve depressive symptoms dramatically, but preoperative depression diagnosis may also increase the risk for poor weight loss. Therefore, we investigated longitudinal associations between depression and inflammatory markers and their effect on weight loss and clinical outcomes in bariatric patients.

This longitudinal observational study of 85 patients with obesity undergoing bariatric surgery included 41 cases with depression and 44 controls. Before and 6 months after surgery, we assessed depression by clinical interview and measured serum high-sensitivity C-reactive protein (hsCRP) and inflammatory cytokines, including interleukin (IL)-6 and IL-10.

Before surgery, depression diagnosis was associated with significantly higher serum hsCRP, IL-6, and IL-6/10 ratio levels after controlling for confounders. Six months after surgery, patients with pre-existing depression still had significantly higher inflammation despite demonstrating similar weight loss to controls. Hierarchical regression showed higher baseline hsCRP levels predicted poorer weight loss (β = −0.28, p = 0.01) but had no effect on depression severity at follow-up (β = −0.02, p = 0.9). Instead, more severe baseline depressive symptoms and childhood emotional abuse predicted greater depression severity after surgery (β = 0.81, p < 0.001; and β = 0.31, p = 0.001, respectively).

Depression was significantly associated with higher inflammation beyond the effect of obesity and other confounders. Higher inflammation at baseline predicted poorer weight loss 6 months after surgery, regardless of depression diagnosis. Increased inflammation, rather than depression, may drive poor weight loss outcomes among bariatric patients.

Depression and overweight are each associated with abnormal immune system activation. We sought to disentangle the extent to which depressive symptoms and overweight status contributed to increased inflammation and abnormal cortisol levels.

Participants were recruited through the Wellcome Trust NIMA Consortium. The sample of 216 participants consisted of 69 overweight patients with depression; 35 overweight controls; 55 normal-weight patients with depression and 57 normal-weight controls. Peripheral inflammation was measured as high-sensitivity C-Reactive Protein (hsCRP) in serum. Salivary cortisol was collected at multiple points throughout the day to measure cortisol awakening response and diurnal cortisol levels.

Overweight patients with depression had significantly higher hsCRP compared with overweight controls (p = 0.042), normal-weight depressed patients (p < 0.001) and normal-weight controls (p < 0.001), after controlling for age and gender. Multivariable logistic regression showed that comorbid depression and overweight significantly increased the risk of clinically elevated hsCRP levels ⩾3 mg/L (OR 2.44, 1.28–3.94). In a separate multivariable logistic regression model, overweight status contributed most to the risk of having hsCRP levels ⩾3 mg/L (OR 1.52, 0.7–2.41), while depression also contributed a significant risk (OR 1.09, 0.27–2). There were no significant differences between groups in cortisol awakening response and diurnal cortisol levels.

Comorbid depression and overweight status are associated with increased hsCRP, and the coexistence of these conditions amplified the risk of clinically elevated hsCRP levels. Overweight status contributed most to the risk of clinically elevated hsCRP levels, but depression also contributed to a significant risk. We observed no differences in cortisol levels between groups.

Antipsychotic depot injections can improve adherence compared to tablets. However, depot prescribing practices differ amongst psychiatrists. Previously, some clinicians perceived an “image” problem for typical antipsychotic depots. This study investigated psychiatrists’ attitudes and knowledge concerning antipsychotic depots (typical and atypical) in an era when patient choice is a pertinent issue.

Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated.

The sample comprised 102 consultant psychiatrists (response rate 102/143, 71%). Their use of depots over the past 5 years had: decreased (50%), not changed (27%), increased (23%). In a forced-choice selection of factors that would persuade them to use depots more, the factor cited as most important was ‘having more atypicals available in long-acting depot form’ (43%). Most regarded depots as being associated with better compliance (89%) and reduced relapse rates (98%) compared to oral medication but only 62% agreed that depots can be used for those with first episode psychosis. A significant minority (33%) believed patients always prefer to have oral medication instead of a depot. 68% believed that patients taking medication of their own free choice is more likely for oral than depot.

During the last 5 years, overall depot prescribing rates have reduced. Most regarded depots as offering better adherence and reduced relapse rates but some remain concerned about the acceptability of depots to patients. These clinician concerns are important but, if extreme, could compromise medication choices offered to patients.

Previously, when only typical antipsychotic depot injections were available, some clinicians perceived depots as having an “image” problem despite them being associated with reduced rates of rehospitalisation when compared to tablets. This study investigated psychiatrists’ attitudes and knowledge concerning depots (typical and atypical) and whether they had changed over time.

Cross-sectional postal survey of consultant psychiatrists working in NorthWest England. A pre-existing questionnaire on clinicians’ attitudes and knowledge regarding depots was updated. Results were compared with a former sample (SouthEast England, 2001: N=143).

The sample comprised 102 consultant psychiatrists (response rate 71%). Depot use over the past 5 years had: decreased (50%), not changed (27%), increased (23%). Psychiatrists with decreased depot use had significantly lower scores for the side effects knowledge subscale than those who had unchanged or increased rates of depot use (mean 51.5% vs 54.8%, p=0.029). When compared to psychiatrists sampled five years previously, our current participants had more favourable patient-focussed attitudes (63.5% vs 60.4%, p=0.034); other subscales did not differ. Item-by-item analysis revealed specific changes over time including significantly less respondents regarding depots as: (i) compromising patient autonomy (mean 0.99 vs 1.28, p=0.036); being stigmatising (1.88 vs 2.42, p=0.002); being old fashioned (1.49 vs 2.04, p=0.002).

During the period that an atypical antipsychotic depot has been available, and depot prescribing rates have reduced, some attitudes have changed. These mainly encompass aspects regarding the patient rather than the depot injection and include reducing concerns about stigma and autonomy although concerns about patient acceptance continue.

Few studies focus on peripheral biological markers of personality. Melatonin (MLT), the main hormonal product of the pineal gland, has been used both as a diagnostic and therapeutic element and has been related with chronotype, depression and schizophrenia, among other psychiatric conditions. However, there is a paucity of studies on its use as a personality marker. The present work aims to determine whether serum MLT levels are related with the Eysenck's personality extraversion/introversion (E/I) dimension.

A sample of 100 healthy volunteers participated in the study. The E/I personality dimension was evaluated using the EPQ-BV (Eysenck Personality Questionnaire – Brief Version). Three blood samples were taken (at 09:00, 12:00 and 00:00 h) to measure MLT. MLT was analysed in serum by an ELISA. Serum MLT concentrations are expressed in pg/ml.

MLT levels displayed a clearly circadian pattern, with night levels being significantly higher than day-time levels (00:00: 35.78 ± 23.53 vs. 09:00: 7.78 ± 5.56, 12.00: 3.35 ± 1.94, p < 0.05). Serum MLT levels at 09:00 h were significantly higher than MLT levels at 12:00 h (7.78 ± 5.56 vs. 3.35 ± 1.94, p < 0.05). No significant correlations were found between E/I scores and serum MLT levels at 09:00 (r = – 0.06, p = 0.55) 12:00 (r = – 0.12, p = 0.25) and 00:00 h (r = – 0.01, p = 0.99).

There is no relationship between MLT levels and the E/I personality dimension. Future studies should examine the neuroticism dimension of personality.

In Ireland, National Clinical Programmes are being established to improve and standardise patient care throughout the Health Service Executive. In line with internationally recognised guidelines on the treatment of first episode psychosis the Early Intervention in Psychosis (EIP) programme is being drafted with a view to implementation by mental health services across the country. We undertook a review of patients presenting with a first episode of psychosis to the Dublin Southwest Mental Health Service before the implementation of the EIP. This baseline information will be used to measure the efficacy of our EIP programme.

Patients who presented with a first episode psychosis were retrospectively identified through case note reviews and consultation with treating teams. We gathered demographic and clinical information from patients as well as data on treatment provision over a 2-year period from the time of first presentation. Data included age at first presentation, duration of untreated psychosis, diagnosis, referral source, antipsychotic prescribing rates and dosing, rates of provision of psychological interventions and standards of physical healthcare monitoring. Outcome measures with regards to rates of admission over a 2-year period following initial presentation were also recorded.

In total, 66 cases were identified. The majority were male, single, unemployed and living with their family or spouse. The mean age at first presentation was 31 years with a mean duration of untreated psychosis of 17 months. Just under one-third were diagnosed with schizophrenia. Approximately half of the patients had no contact with a health service before presentation. The majority of patients presented through the emergency department. Two-thirds of all patients had a hospital admission within 2 years of presentation and almost one quarter of patients had an involuntary admission. The majority of patients were prescribed antipsychotic doses within recommended British National Formulary guidelines. Most patients received individual support through their keyworker and family intervention was provided in the majority of cases. Only a small number received formal Cognitive-Behavioural Therapy. Physical healthcare monitoring was insufficiently recorded in the majority of patients.

There is a shortage of information on the profile and treatment of patients presenting with a first episode of psychosis in Ireland. This baseline information is important in evaluating the efficacy of any new programme for this patient group. Many aspects of good practice were identified within the service in particular with regards to the appropriate prescribing of antipsychotic medication and the rates of family intervention. Deficiencies remain however in the monitoring of physical health and the provision of formal psychological interventions to patients. With the implementation of an EIP programme it is hoped that service provision would improve nationwide and to internationally recognised standards.

Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.

We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.

Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).

Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.