This study explores psychiatrists’ perceptions of Attention-Deficit Hyperactivity Disorder (ADHD) through the lens of evolutionary psychiatry, a growing field that reframes mental disorders in the context of adaptation and survival. Evolutionary theories suggest that traits associated with ADHD, such as impulsivity, hypercuriosity and novelty-seeking, may have been adaptive in ancestral environments, though they manifest as maladaptive in structured modern contexts.

A bespoke 10-item questionnaire was developed to assess psychiatrists’ attitudes following a presentation on evolutionary perspectives of ADHD by an expert. The questionnaire allowed rating in 5-point Likert fashion and was followed by a free text box for qualitative analysis. Basic descriptive statistics and One-Way ANOVA pairwise comparisons between groups was used to test for statistical significance. A p value of <0.05 was deemed statistically significant.

Forty-two participants, including 21 consultants and 19 psychiatry trainees completed the questionnaire. All participants rated their comprehension of the presentation as high/very high. Most strongly agreed that the information presented could improve psychiatry and therapeutic outcomes. However, consultants with more than 10 years of experience were less likely than trainees to report optimism about the practical applications of evolutionary frameworks. Qualitative feedback emphasized the relevance of evolutionary perspectives in clinical practice, particularly in reducing stigma and enhancing therapeutic engagement with patients and families.

While the results from this study were positive, limitations include the small sample size and lack of prepresentation baseline data. However, this study has formed part of the first step in investigating the perceptions and attitudes of psychiatrists on evolutionary perspectives on ADHD.

Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals’ views on ethical conflicts arising from such refusals.

The objective of this study was to explore professionals’ perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.

We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.

Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.

Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.

To estimate the coexistence of autism spectrum disorder (ASD) traits in an adult sample diagnosed with attention-deficit/hyperactivity disorder (ADHD); to compare individuals with ASD traits to those without, in terms of functionality, quality life and clinical outcomes; to explore the effects of ADHD medication on three main outcomes (clinical, quality of life, and functionality) in those with only ADHD and in those with coexistence of ASD and ADHD

Prospective longitudinal study of an adult sample diagnosed with ADHD. Data were collected on age, gender, medications and on scales: Autism Spectrum Quotient (AQ-10); Adult ADHD Clinical Outcome Scale; Adult ADHD Quality of Life Questionnaire; Weiss Functional Impairment Rating Scale.

A sample of 165 participants was recruited. The AQ-10 showed that almost half, n = 74 (44.8%) of the participants had traits of ASD. Longitudinal analyses demonstrated that people with ADHD and ASD traits have worse clinical outcomes, quality of life, social skills, and family functioning, compared to those with ADHD only.

The study shows a high rate of co-existence of ASD in adults with ADHD. Comorbid ASD traits were associated with poorer overall clinical and functional outcomes, quality of life, social skills, and family functioning. Study limitations with particular reference to dropout rate are considered. Implications for improving services are discussed.

This paper examines rates of physical restraint and seclusion under the Mental Health Act 2001 in acute adult psychiatry inpatient facilities (“approved centres”) in Ireland.

Analysis of rates of physical restraint and seclusion in acute adult approved centres in Ireland in 2023, based on data made publicly available by the Mental Health Commission, Health Research Board, and Central Statistics Office.

Rates of physical restraint vary 16-fold between approved centres, ranging from 116 episodes of physical restraint per 100,000 population per year to 7 per 100,000 population, with a national rate of 39 per 100,000 population. Among the six approved centres with the highest rates of physical restraint, five are in Dublin (i.e. urban). Among approved centres that use seclusion, rates vary 19-fold, ranging from 38 episodes of seclusion per 100,000 population to 2 per 100,000 population, with a national rate of 15 per 100,000 population.

There are within-country variations in rates of physical restraint and seclusion in Ireland, but these are of a lesser magnitude than between-country variations. Overall, Ireland’s rates of restrictive practices are lower than those in other jurisdictions, consistent with Ireland’s low rate of involuntary admission. Future research could usefully focus on the relationship between restrictive practices and urbanicity, among other themes.

Patient death by suicide is a distressing occupational event associated with far-reaching impacts on professional practice and wellbeing. Psychiatrists are commonly tasked with suicide risk assessment and management and ultimately experience greater incidences of patient suicide in comparison with other medical specialists. Therefore, it is important to understand psychiatrists’ experiences of patient suicide and the required supports in an Irish context. This study investigated how patient suicide affects the personal and professional lives of consultant and non-consultant psychiatrists, and what resources/systems psychiatrists find helpful in mitigating the impact of a patient suicide.

Survey data collected from 232 consultants and non-consultant clinicians was analysed using frequency analyses and Independent Samples t-tests,. Most participants were female (61.6%) and the largest age group represented was 50–59 years (28.4% of the sample).

Key personal and professional impacts in the aftermath of a patient’s suicide include pre-occupation with suicide, decreased self-confidence, sadness, burnout, desire for career change/break and fear of negative events following the suicide. A significant difference was observed across gender with respect to sense of responsibility (F = 3.69, dfs = 2,200, p = .026) with females displaying more feelings of responsibility (M = 3.9, SD = 3.1) than males (M = 2.8, SD = 2.7). Support from colleagues and line managers was largely identified as helpful in the aftermath of patient death by suicide.

Ultimately, there is a need for greater access to guidelines/policy and occupational support for psychiatrists to assist their responses. This study provides much-needed insight into the landscape of experiences and needs of psychiatrists in Ireland who experienced a patient death by suicide.

To examine the knowledge, experience and attitudes of nurses working in nursing homes in relation to the administration of antipsychotic medications to individuals diagnosed with behavioural and psychological symptoms of dementia (BPSD).

Questionnaires comprising 17 questions were distributed to 120 nurses working in nursing homes to evaluate their knowledge of and attitudes to the utilisation of antipsychotic medication for BPSD.

Of the 70 nurses who completed the study questionnaire, 68 (97.1%) were confident with their knowledge of managing BPSD symptoms in dementia patients; 49 (70.0%) stated that antipsychotic medications were associated with a noticeable improvement in BPSD symptoms (n = 49, 70.0%) and were mostly commenced at an appropriate stage of the patients illness (n = 47, 67.1%). Music therapy was the most commonly noted (58.6% of nurses) utilised alternative therapy, although only 46% nursing staff reported that there were sufficient alternative therapies available. Qualitative themes of note included the importance of communication between nursing staff, health professionals and family members and an ongoing requirement for training nursing staff regarding antipsychotic prescribing and dispensing in BPSD.

Nurses working in nursing homes demonstrated confidence in their knowledge of treatment strategies in managing BPSD in dementia patients. However, concerns were expressed regarding the limited availability of non-pharmacological interventions.

Meaning-making in psychotic experiences may affect mental health recovery by influencing the degree to which a person experiences Meaning in Life (MIL). However, how meaning made in such experiences impacts MIL is poorly understood. We aimed to explore how service users engage in meaning-making in their experience of a first-episode psychosis (FEP) (as well as subsequent and current psychotic experiences), and to identify if and how this meaning has influenced their current perspective on MIL.

The study aim was addressed using Interpretative Phenomenological Analysis (IPA). We used purposive maximum variation sampling and conducted semi-structured interviews with 16 members of an epidemiologically complete FEP incidence cohort in the Republic of Ireland. Data analysis was guided by IPA procedures.

We found psychotic experiences both contributed to and eroded MIL but also created memory blanks, blocking the process of meaning-making. Meaning-making in psychotic experiences involved: Living with the impact of psychosis on the self and identity (Survival); Reconnecting with time to move forward in time (Restoring temporality); Navigating agency and powerlessness in chaos (Reclaiming control); Generating Meaning in Life in a vacuum (Presence in absence); and Trying to find a home for psychosis or not needing to (Narrative re-storying).

Findings challenge current meaning-making theory; suggesting that it may not be fully applicable to the lives of people experiencing psychosis. Our data also have implications for the implementation of trauma informed care, the recovery approach in mental health, clinical practice, and research.

Second-generation antipsychotics (SGAs) are moderately effective treatments for psychotic disorders but are associated with significant weight gain and metabolic complications. These contribute to a nearly 20-year reduction in life expectancy for individuals with enduring psychotic illness. Weight gain can also negatively impact adherence, increase relapse risk, and worsen psychosocial outcomes.

To highlight the mechanisms underlying antipsychotic-induced weight gain (AIWG), examine pharmacological strategies for its prevention and treatment, and argue for the early use of metformin.

This perspective article synthesises current evidence on the pathophysiology of AIWG and evaluates the role of metformin in mitigating these effects.

Weight gain can occur rapidly after initiating antipsychotic treatment, particularly in young people and those prescribed antipsychotics for non-psychotic indications. Presentation and response to interventions vary. Of all pharmacological strategies, metformin has the most robust evidence for both prevention and treatment of AIWG. It is a well-tolerated, low-cost antihyperglycaemic agent with an established safety profile. Metformin should be considered early in the course of antipsychotic treatment for all individuals, regardless of diagnosis, to prevent clinically significant weight gain and reduce long-term health risks. Early intervention may improve adherence, reduce relapse, and enhance overall quality of life.

Most mental health difficulties have their onset in early adolescence. Increasingly, community based primary care is recognised as a critical pathway to early intervention. Despite encouraging initial evaluations, there is an ongoing need for evidence of the outcomes of primary care youth mental health programmes delivered at scale. This brief report examines reliable improvements in psychological distress and user satisfaction data from a national primary care youth mental health programme in the sustainment phase of implementation.

This report takes a multi-methods approach to routine evaluation data. Young people (aged 12–25; N = 8,721) completed Clinical Outcomes Routine Evaluation (CORE-10 and YP-CORE) pre- and post-treatment. Clinical cut offs and a reliable change index (based on established guidelines) were used to report rates of reliable improvement. The analysis examined differences in outcomes based on age, gender, and clinical need. Satisfaction was measured using the youth service satisfaction survey (N = 4,267). Natural language processing techniques were employed to objectively analyse qualitative user feedback.

Most young people presented in the clinical range, with almost two-thirds reporting moderate to severe distress. Statistically significant reductions in distress were observed with large effect sizes (d = 1.08–1.28). Young people in the clinical range demonstrated significantly higher rates of reliable improvement compared to those who presented in the healthy range. In line with similar evaluations, young adults were more likely to achieve improvement and report higher satisfaction. Sentiment analysis of satisfaction data indicated a strong skew towards positive sentiment, with trust, anticipation and joy being predominant. Qualitative feedback pointed to waiting times as an improvement area.

The absence of a control group limits our ability to evaluate the effectiveness of the service interventions. Nonetheless after a decade of service delivery, these results indicate that large scale national youth mental health programmes can achieve satisfaction and clinical outcomes in line with international standards. Further research is needed on the predictors of reliable change, differences across demographic groups and approaches to improving waiting times in primary care.

To investigate levels of knowledge and attitudes towards advance healthcare directives among inpatient psychiatry service users in Ireland.

A survey was completed among adult inpatient psychiatry service users (n = 47) in Tallaght University Hospital, Dublin.

Just over one in ten (11%) inpatient psychiatry service users had heard of advance healthcare directives. None had created an advance healthcare directive, but over a quarter (25.5%) had written down or verbally told someone what they would like to happen when they became unwell. When asked ‘if you were supported by your healthcare provider to make an advance healthcare directive, would you like to make one?’, over two thirds responded either ‘definitely yes’ (34%) or ‘probably yes’ (34%). On multi-variable testing, future willingness to make an advance healthcare directive was significantly associated with younger age but not with ethnicity, gender, education, employment status, or prior knowledge of advance healthcare directives. All respondents would involve someone else in making an advance healthcare directive. There was high confidence that healthcare practitioners would respect an advance healthcare directive (87%).

There are high levels of interest in advance healthcare directives, but low levels of knowledge and use among inpatient psychiatry service users in Ireland. Our findings indicate a need for educational initiatives and resources to increase awareness. Such efforts could usefully focus especially on appropriate use of advance healthcare directives in psychiatric care and seek to bridge the gaps between evidence of benefit, legislative reform, and their use in mental healthcare.

This study aimed to evaluate the general practitioner (GP) referral pathway for adult attention deficit hyperactivity disorder (ADHD) devised by the Irish Health Service Executive’s (HSE) National Clinical Programme for Adult ADHD (NCPAA). Primary objectives were to (i) quantify GP referrals to community mental health teams (CMHTs) for adult ADHD screening, (ii) measure workload on CMHTs related to screening adult ADHD referrals without comorbid mental health problems, and (iii) quantify access to adult ADHD screening through CMHTs and subsequent assessment and treatment access through specialist adult ADHD teams.

An observational cohort design was used to retrospectively analyse ADHD-related referral data collected by clinical staff across 11 Irish CMHTs, and three specialist adult ADHD teams from January to December 2023.

There was high variability in adult ADHD referrals to CMHTs, ranging from 14 to 122 over one year. There was also high variability in the number of referrals seen by CMHTs, ranging from 9 to 82. From 304 referrals seen across 11 CMHTs, 25.3% required initial treatment for another mental health condition. Specialist adult ADHD teams received 3–4 times more referrals than they were able to assess during this timeframe.

The NCPAA has provided crucial services for adults with ADHD in Ireland. However, an increase in neurodiversity awareness and demand for services suggests that a range of referral pathways depending on complexity level may be required. Alternative models are proposed, which require allocation of resources and training through primary care, secondary mental health services and specialist teams.

Older adults are more likely to develop delirium with COVID-19 infection. This cross-sectional cohort study was designed to explore the risk factors of delirium in hospitalized older adults with COVID-19 and to evaluate whether delirium is an independent predictor of mortality in this cohort of patients.

Data were collected through a retrospective clinical chart review of patients aged 65 years or older who were admitted to St. James’s Hospital between March 2020 and 2021 who tested positive for SARS-CoV-2 infection.

A total of 261 patients (2.8 % of total admissions 65 years or older) were included in this study. Patients who developed delirium were older (80.8 v. 75.8 years, p < 0.001), more likely to have pre-existing cognitive impairment (OR = 3.97 [95% CI 2.11–7.46], p < 0.001), and were more likely to be nursing home residents (OR = 12.32 [95% CI 2.54–59.62], p = 0.0018). Patients who developed delirium had a higher Clinical Frailty score (mean 5.31 v. 3.67, p < 0.001) and higher Charlson Co-morbidity index (mean 2.38 v. 1.82, p = .046). There was no significant association between in-hospital mortality and delirium in the patient cohort (p = 0.13). Delirium was associated with longer hospital stay (40.5 days v. 21 days, P = 0.001) and patients with delirium were more likely to be discharged to nursing homes or convalescence instead of home (OR = 8.46 [95% CI 3.60–19.88], p < 0.001).

Delirium is more likely to occur in COVID-19 patients with pre-existing risk factors for delirium, resulting in prolonged admission and functional decline requiring increased support for discharge.