St Patrick's University Hospital (Irish: Ospidéal Ollscoile Naomh Pádraig) is a teaching hospital at Kilmainham in Dublin. The building, which is bounded by Steeven's Lane to the east, and Bow Lane West to the south, is managed by St Patrick’s Mental Health Services.
Background Older people with depression exhibit better response to electroconvulsive therapy (ECT). We aimed to measure the total effect of age on ECT response and investigate whether this effect is mediated by psychotic features, psychomotor retardation, psychomotor agitation, age of onset, and episode duration. Methods We pooled data from four prospective Irish studies where ECT was administered for a major depressive episode (unipolar or bipolar) with baseline score ≥21 on the 24-item Hamilton Depression Rating Scale (HAM-D). The primary outcome was change in HAM-D between baseline and end of treatment. The estimands were total effect of age, estimated using linear regression, and the indirect effects for each putative mediator, estimated using causal mediation analyses. Results A total of 256 patients (mean age 57.8 [SD = 14.6], 60.2% female) were included. For every additional 10 years of age, HAM-D was estimated to decrease by a further 1.74 points over the ECT period ( p < 0.001). Age acted on all putative mediators. Mechanistic theories, whereby a mediator drives treatment response, were confirmed for all putative mediators except age of onset. Consequently, mediation of the effect of age on change in HAM-D could be demonstrated for psychotic features, psychomotor retardation, psychomotor agitation, and episode duration but not for age of onset. Conclusions A total of 43.1% of the effect of older age on increased ECT response was explained by the mediators. Treatment planning could be improved by preferentially offering ECT to older adults, especially if presenting with psychotic features, greater severity of psychomotor disturbance, and earlier in the episode.
Retrograde amnesia for autobiographical memories is a commonly self-reported cognitive side-effect of electroconvulsive therapy (ECT), but it is unclear to what extent objective performance differs between ECT-exposed and ECT-unexposed patients with depression. We investigated the association between exposure to brief-pulse (1.0 ms) bitemporal or high-dose right unilateral ECT and retrograde amnesia at short- and long-term follow-up, compared with inpatient controls with moderate-to-severe depression without lifetime exposure to ECT and receiving psychotropic pharmacotherapy and other aspects of routine inpatient care. In propensity score analyses, statistically significant reductions in autobiographical memory recall consistency were found in bitemporal and high-dose right unilateral ECT within days of an ECT course and 3 months following final ECT session. The reduction in autobiographical memory consistency was substantially more pronounced in bitemporal ECT. Retrograde amnesia for items recalled before ECT occurs with commonly utilised ECT techniques, and may be a persisting adverse cognitive effect of ECT.
Background:The infection of Pneumocystis jirovecii pneumonia (PJP) increases the rate of malignancy-related death. It is crucial to estimate the risk of PJP in this population. Peripheral blood neutrophil-to-lymphocyte ratio (NLR) has been proven to have significant value in predicting bacterial infection. However, the associations between peripheral blood NLR and PJP in patients with solid tumors have not been investigated. We aimed to identify whether baseline peripheral-blood NLR was correlated with PJP in patients with solid tumors. Methods:We retrospectively reviewed medical records of all consecutive patients with solid tumors and a proven diagnosis of PJP according to the European Organization for Research and Treatment of Cancer (EORTC) consensus definitions. Patients were randomly grouped into a discovery cohort and a validation cohort in a 2:1 ratio. Propensity score matching was performed in a 1:2 ratio between patients with PJP and those without PJP. Demographic and clinical data were collected, which included malignancy types, baseline NLR, chest imaging, coexisting pulmonary disease, and treatment regimens. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of NLR for analyzing risk of PJP. Multivariate logistic analysis was performed to identify the risk factors of PJP. Results:A total of 249 patients were included, of whom 83 had PJP infection and 166 did not. A total of 157 (63.1%) patients were aged 65 years or older, 73.5% of participants were male, and 37.3% were never-smokers. Patients with PJP had a higher NLR level than those without PJP (P<0.001). The optimal threshold of NLR to predict PJP was 6.22. Multivariate analysis revealed independent associations with higher NLR (odds ratio: 4.96; 95% confidence interval: 1.82-13.50; P=0.002) and PJP after adjustment for age, sex, and smoking status. The incidence of PJP in the high-NLR subgroup (NLR ≥6.22) was significantly higher than that in the low-NLR subgroup (NLR <6.22) in the discovery (65.3% vs. 19.8%; P<0.001) and validation cohorts (65.4% vs. 19.0%; P<0.001). Moreover, NLR was negatively correlated with absolute CD4 and CD8 cell count. Patients with high NLR had a lower mean absolute CD4 and CD8 cell count than those with low NLR. Conclusions:Among patients with solid tumors, a baseline feature of high NLR (≥6.22) was independently associated with an increased risk of PJP development. Furthermore, the NLR demonstrates potential utility in assessing immune status. Therefore, clinicians should consider initiating PJP prophylaxis earlier or performing earlier PJP screening in patients with solid tumors and elevated peripheral blood NLR.
INTRODUCTION:Personality disorders, characterised by pervasive emotional and interpersonal dysfunction, are integral to psychiatric practice. This service review estimated the prevalence of personality disorders in a psychiatric inpatient setting and looked at various clinical and demographic factors of interest. METHODS:Data were retrospectively collected from 526 patients discharged from St Patrick's University Hospital in 2019-2020 under the care of two consultant-led teams. Demographic and clinical data such as age of first mental health contact, number of previous admissions, and risk history were recorded as well as the use of the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). RESULTS:37% of the sample had at least one personality disorder, with borderline (24.9%), avoidant (13.3%) and obsessive-compulsive (7.6%) being the most common subtypes. Notably, in 72.1% of cases the diagnosis was new. High comorbidity was observed, particularly with affective (47.7%) and anxiety disorders (28.4%). Patients with personality disorders exhibited high rates of self-harm (45%) and suicide attempts (40%). DISCUSSION:The review highlighted potential delays in diagnosis, with an average of 15 years of mental health service contact prior to diagnosis. The findings underscore the need for specialised services and further research to better understand and manage personality disorders in the Irish psychiatric setting. Limitations include the specific sample from a private mental health facility and the high use of structured interviews, which may affect the generalisability of the results to other settings. This review contributes valuable data to the limited research on personality disorder prevalence in Irish psychiatric services.
Introduction:Trauma is the leading cause of death among individuals aged 1-44 years, and it is estimated that many of these deaths could be prevented. Clinical guidance is an essential step toward the optimization of trauma care, especially within rural environments. This qualitative case series seeks to better understand how trauma clinical guidance (TCG) plays a role in rural trauma providers' patient management. Methods:An initial exploratory qualitative case series consisting of five semi-structured interviews with rural providers recruited using snowball sampling from existing professional networks were conducted between February and April 2024. Providers were asked to provide details on how they approach clinical uncertainty and if clinical guidance plays a role in their decision making. Then, providers performed real-time reviews of clinical guidance documents, identifying areas for clinical guidance improvement. Interviews were recorded, transcribed, and data analyzed using narrative and thematic approaches, with key themes identified through peer debriefing with relevant quotes selected. Results:Of the five providers interviewed, three provide care at a critical access hospital, one provides care at a level II trauma center, and one at a level III trauma center. Two interviewees mentioned that they do not use clinical guidance often in direct patient care, and three highlighted the use of advanced trauma life support as the foundation of their practice on which they expand their tools and training. Common requests of TCG from rural providers included: (1) visual components to guide workflow, (2) easy discoverability in a central place, (3) relevant across various resource settings, (4) a centralized 'stamp of approval,' for guidelines that have been mutually agreed on via extensive collaboration, and (5) transfer guidance. Conclusion:The needs of rural trauma providers should be a focal point when working to improve the creation and dissemination of TCG. Collaboration when creating new TCG is essential. By intentionally designing for the rural population, we will increase the reach and impact of the guidance developed, as well as improve its accessibility and usability for all providers, regardless of resource setting. Through these efforts, we will decrease the disparate burden of trauma and unintentional injury on rural patients and their healthcare providers. Level of evidence:Level V.
