An Early Intervention in Psychosis (EIP) programme aims to engage patients in early assessment and phase-specific interventions which are the key elements of the Irish National Clinical Programme for psychosis. This study aims to describe and review the EIP programme offered by Cork’s North Lee Mental Health Services over a 5-year period.

A retrospective descriptive study design was adopted to describe and review the EIP programme, patient demographics and treatments offered in the service over a 5-year period.

A total of 139 patients were accepted into the programme over the 5-year period. The mean age of onset was 30 years (median = 28, SD = 9.9), and the mean duration of untreated psychosis was 8 months (median = 2.5, SD = 15.3). Two-thirds of patients were single on initial assessment, had a history of substance misuse and were unemployed. The majority of the cohort engaged with the keyworkers and occupational therapy but did not complete the full psychological or family programmes offered. Hospital admission was required for 12% of the cohort.

Patients experiencing their first episode of psychosis can successfully be treated in the community with appropriate professional and family support. However, deficiencies were noted in physical health monitoring, as well as in the availability and engagement with family and psychological therapies. Properly resourced early interventions in psychosis teams are necessary to deliver services at internationally recognised standards.

Home-based crisis team (HBCT) in North Cork was established in 2013 to provide short term, intensive home treatment to people who are experiencing acute mental health problems, with the aim of averting hospital admission wherever possible or supporting patients discharged from hospital.

A retrospective descriptive study design was adopted to describe the activities of the North Cork HBCT over a 1 year period. Data were analysed using R version 3.4.0 for Windows.

A total of 388 patients were referred to the HBCT in 2015, of which 328 required assessments. General practitioners (GPs) made 56% of all referrals. The most common referral reason was low mood (40%). Stepped-up care to the psychiatric inpatient unit was required for 12.4% of patients, 62% were discharged to the outpatient clinic for routine follow-up.

Many common psychiatric presentations can be managed at home with the support of the HBCT although hospital admission is required for significant numbers.

To examine similarities and differences in the demographic and clinical profiles of young people (15–25 years of age) referred between the mental health services (MHS) and Jigsaw Galway.

A retrospective chart review was conducted of clinical files of individuals attending secondary MHS who had been referred to or from Jigsaw Galway over a 5-year period. Differences in demographic and clinical data between individuals referred to or from Jigsaw Galway were compared.

A recent act of self-harm was more prevalent in individuals referred from Jigsaw to the adult MHS (p=0.02). No other demographic or clinical differences were detected between individuals attending Jigsaw Galway and the MHS.

Education sessions for clinical staff working in primary care, Jigsaw Galway and the MHS are suggested to support clinicians in choosing the best referral pathway, which may more optimally address young people’s mental health difficulties.

To describe the behavioural and psychiatric problems found in nursing home psychiatric referrals in the Dublin South city area.

We undertook two consecutive surveys of nursing home referrals to the St James’s Hospital psychiatry of old age service over a 2-year period. During the second survey a new clinical nurse specialist was specifically appointed to manage the seven nursing homes included in the study.

The most common reason for referral during survey one was uncooperative/aggressive behaviour (22%). For survey two, patients were most commonly referred for low mood (31%) or agitation (29%). During survey one, the majority of patients assessed were diagnosed with behavioural and psychological symptoms of dementia (41%). This was also a prevalent diagnosis during survey two, affecting 27% of those referred. Only 7% of patients were considered to be delirious during survey one. This rose to 31% the following year making it the most common diagnosis during survey two. Over the 2-year study period, 7% of referred patients were diagnosed with depression. In terms of prescribing practices, the discontinuation rate of antipsychotic mediation following psychiatric input was 13% in survey one. By survey two, this had risen to 47%.

Delirium is often undetected and untreated in nursing homes. Residents presenting with psychiatric symptoms should undergo routine bloods and urinalysis prior to psychiatric referral. Dedicated input from trained psychiatric nursing staff can lead to both an improvement in the recognition of delirium and reduced prescribing rates of antipsychotic medication.

Mental health is regarded as more than the absence of mental health difficulties, with clinical and research focus moving towards measurement of well-being. The Mental Health Continuum-Short Form (MHC-SF) was developed to assess overall and emotional, social and psychological well-being. Little is known about the use of the MHC-SF with young people engaging with mental health services. The current pilot study sought to examine the performance of the MHC-SF in an Irish primary care youth mental health service for 12–25 year olds.

A sample of 229 young people (female n=143; male n=85, unknown n=1) aged 12–24 years (M=15.87, SD=2.51) who completed the MHC-SF prior to commencing their first intervention session in Jigsaw participated in this study. The psychometric properties of the MHC-SF were investigated using confirmatory factor analysis (CFA) and Cronbach’s alpha for internal consistency.

CFA supported the three-factor structure of the MHC-SF for emotional, social, and psychological well-being, and very good internal consistency was observed.

Findings provide evidence for the psychometric properties of the MHC-SF in a primary care youth mental health setting, and suggest that the MHC-SF’s three-factor structure is valid for use in this context. Limitations and recommendations for future research are discussed.

In this paper we provide revised estimates of the prevalence of dementia in Ireland, the number of new cases per year and the severity mix. These estimates are a necessary input for any assessment of the potential demand for services and supports for people with dementia across all care settings in Ireland.

The prevalence, incidence and severity stage of dementia are calculated by applying rates from prominent international studies to population data from the 2016 census.

We show that the total number of people with dementia in Ireland ranges between 39 272 and 55 266, depending on the international rates used to measure prevalence. The incidence of dementia in Ireland has increased as the population has aged, to at least 7752 new cases per year. We estimate that there are at least 11 175 people living at home in the community in Ireland with dementia who have a serious functional impairment, based on an Activities of Daily Living measurement, of which an estimated 1876 are chair or bedbound.

Without a national prevalence study it is not possible to be precise about the estimates of the number of people with dementia in Ireland. However, having credible upper and lower bound estimates for the number of people with dementia, the potential number of new cases per year and severity rates is useful for planners and those charged with the responsibility of making resource allocation decisions in dementia.

To systematically review studies from Irish prisons that estimate the prevalence of major mental illness, alcohol and substance misuse, and homelessness at the time of committal.

Healthcare databases were searched for studies quantifying the point prevalence for each outcome of interest. Searches were augmented by scanning of bibliographies and searches of governmental and non-governmental websites. Proportional meta-analyses were completed for each outcome.

We found eight, six and five studies quantifying the point prevalence of major mental illness, substance misuse, and homelessness respectively. Considerable heterogeneity was found for each subgroup (except psychosis where substantial heterogeneity was observed) and random effects models were used to calculate pooled percentages. The pooled percentage for psychotic disorder was 3.6% [95% confidence interval (CI) 3.0–4.2%], for affective disorder 4.3% (95% CI 2.1–7.1%), for alcohol use disorder 28.3% (95% CI 19.9–37.4%), for substance use disorder 50.9% (95% CI 37.6–64.2%) and for those who were homeless on committal 17.4% (95% CI 8.7–28.4%).

Estimates for the prevalence of psychotic illness and substance abuse amongst Irish prisoners are in keeping with international estimates of morbidity in prisons, whilst those for affective disorders are lower. The prevalence of homelessness in committal to Irish prisons is higher than some international estimates. Rates for psychoses, alcohol and substance misuse as well as homelessness in Irish prisons are significantly higher than the general population prevalence of these vulnerabilities. A need for service development is discussed.

The aim of this scoping review was to map evidence gathered through systematic reviews regarding adult attachment and mental health difficulties. This review highlights established, emerging, and inconsistent findings, suggesting areas for future research, and implications for theory and practice.

A systematic search for meta-analyses and systematic reviews measuring adult attachment and concerning mental health difficulties was conducted. In total, 17 studies met the selection criteria.

Findings were presented according to four identified themes, (1) measurement of attachment; (2) measurement of mental health difficulty; (3) intrapersonal processes related to attachment and mental health difficulties; and (4) interpersonal processes related to attachment and mental health difficulties.

This review highlights the connection between attachment style and mental health difficulties, and suggests that relationships can facilitate both mental health and illheath. However, the mechanisms through which insecure attachment confers risk for mental health difficulties require further research.

The majority of people living with dementia in Ireland reside in their own homes, some supported by formal or informal home care. This audit aimed to estimate the prevalence of dementia and suspected cognitive impairment (CI) among older adults, 65+ years, in receipt of formal home care (domiciliary care) in a defined health service area in North Dublin. A secondary objective of the audit was to explore factors associated with dementia or CI in this cohort.

A cross-sectional audit was conducted on all clients aged 65+ years actively receiving publicly funded home care packages (HCPs) during May 2016 in Healthcare Service Executive CHO9 Dublin North Central. A total of 935 urban community dwelling older adults were included in the study [mean age 83.7 (s.d. 7.4) years and 65% female]. Basic socio-demographic and health data were extracted from common summary assessment reports. Service users were categorised as having (a) dementia if a diagnosis of dementia or cognitive decline which impacts on independent living, was documented by a health professional or (b) suspected CI where a validated cognitive screening tool was applied and the score was indicative of mild CI.

Overall, the estimated prevalence of dementia and suspected CI was 37.1% and 8.7%, respectively. Factors significantly associated with dementia and suspected CI were higher dependency and home care hours, communication difficulty and being non-self-caring (p<0.001). Notably, half (51.6%) of those with either dementia or suspected CI group lived alone.

Our findings suggest a high prevalence dementia among HCP users, highlighting a need and opportunity for dementia-specific approaches to support older people in their homes.

To investigate whether a small regional memory clinic would benefit from engaging with a structured external audit process such as the Royal College of Psychiatrists’ Memory Service National Accreditation Program (MSNAP).

The Psychiatry of Old Age service in Navan operates a public cognitive clinic. Despite the publication of the 2014 National Dementia Strategy, there are currently no national standards for memory clinics in Ireland. It may be beneficial to link in with an external quality control system as part of routine clinical governance.

Published data from the MSNAP group was reviewed and a set of audit materials extrapolated to replicate the MSNAP self-review process. The audit cycle involved (1) retrospective case review, (2) institution of a range of interventions and (3) a prospective audit, which included service user feedback.

Overall the results demonstrated a high standard of service, especially in the areas of accessibility, assessment and communication of diagnosis. The clinic performed well against MSNAP key performance indicators. Patient and carer satisfaction with the service was very high. Clinic policies needed further development, particularly in the areas of referral, consent and data protection.

The process was useful, providing clear pointers for action. It highlighted the need to formalise organisational and practice policies, patient support and education, audit and outreach. Although accreditation is a laborious process requiring financial investment, it provides a strong scaffold to maintain and improve standards and is likely to be a valuable learning experience, where national guidelines are lacking.

We review studies of whether cortisol levels following psychosocial stress exposure differ between patients with psychosis and healthy control subjects.

Original research published between 1993 and February 2019 was included in the literature search. Studies that used experimentally induced psychosocial stress and reported stress response measures of plasma or saliva cortisol levels in patients at any stage of illness (i.e. high risk, first episode and chronic phase) were included.

A total of 17 studies were included. Although there was evidence of inconsistencies in measures, we observed moderate evidence of an association with stress-induced cortisol blunting response across studies.

This review highlights recent evidence of blunting of cortisol response following experimentally induced psychosocial stress. While there was some evidence of this blunted response across illness types and stages, the strongest evidence was observed for those with chronic schizophrenia. Due to the low number of studies, in particular in bipolar disorder, much work is still needed to accurately characterise the biological effects of stress in psychosis.