OBJECTIVES:In Ireland, data on dual diagnosis (DD) is limited. This study aims to describe the characteristics of deaths among people who both used drugs and had a mental health (MH) condition to better understand DD and to help improve the provision of DD services in Ireland. METHODS:Data from the National Drug-Related Deaths Index (NDRDI) was used to identify deaths among people who used drugs and had history of at least one MH condition. Sociodemographic characteristics, risk factors, substance use, MH conditions, and type and cause of death, stratified by sex, were analysed descriptively. Variance by MH condition was examined using cross tabulation. RESULTS:Between 2019 and 2021, 567 deaths met the inclusion criteria. The majority (67.9%) were men. The mean age was 42 years. The most common drugs used were cocaine (47.6%), heroin (37.4%) and cannabis (36.3%). The most common MH conditions were depressive disorders (52.7%), anxiety disorders (36.7%) and specific personality disorders (16.6%). Misadventure (46.6%) and suicide (27.2%) were the most frequent verdicts recorded. Almost equal proportions of deaths were poisonings (48.9%) and non-poisonings (51.1%). Most poisoning deaths involved an opioid-type drug and/or polysubstances (83.8%). CONCLUSION:The NDRDI data enables in-depth description of those who died with DD in Ireland. While it does not provide comparisons with those who survived, given the limited amount of research in this area in Ireland, the data contributes valuable insights into the issue.
Population displacement is a current, accelerating global trend and countries have legal obligations to offer asylum seekers refuge and timely rehabilitation. The mental health of this population is shaped by traumatic experiences, making access to specialist mental health services a critical part of meeting responsibilities. This perspective paper explores Ireland's mental health services for refugees and asylum seekers and finds it insufficiently equipped due to underfunding, workforce shortages, lack of specialist units and insufficient numbers of specialist trained psychotherapists. Comparative European examples indicate that targeted policies, coordinated investment, and specialist workforce are essential to support legal obligations and meaningful integration. These findings aim to prompt Irish policymakers and healthcare providers to consider strategic reform.
Athletes often experience high rates of burnout, which has known links to depressive/somatic symptoms. However, little is known of the role that resilience plays in shaping these outcomes. The study aimed to examine the mediating role of resilience (personal and relational) in the relationship between burnout (emotional and physical exhaustion, reduced sense of accomplishment, sport devaluation) and depressive/somatic symptoms in Gaelic Games athletes. Participants (N = 225), were invited to an online survey, where they responded to a series of self-report measures and demographic questions. Structural equation modelling was employed to examine the mediating effect of resilience on the relationship between burnout and depressive/somatic symptoms. Findings indicate that interventions promoting relational resilience, such as peer-support initiatives, may protect against the impact of emotional/physical exhaustion on depressive symptoms. However, strategies aimed at developing personal resilience, such as psychological skills training, may reduce the impact of a reduced sense of accomplishment on somatic symptoms.
BACKGROUND:Women from ethnic minorities experience disproportionately high rates of self-harm and suicide. In Ireland, Irish Travellers have an indigenous presence on the island dating back centuries. Although Traveller women are known to be at increased suicide risk, little is understood about their experiences with healthcare during suicidal crisis. AIMS:This study sought to explore how Traveller women make sense of their experiences when presenting to emergency departments (EDs) in suicidal crisis, and how they perceive their interactions with clinicians. METHODS:Interpretative Phenomenological Analysis (IPA) was employed to capture culturally specific meaning-making around a highly sensitive topic. Two Traveller women were purposively sampled from a deliberately homogeneous subgroup. Each case was analysed independently, followed by a cautious cross-case synthesis to identify shared experiential themes. RESULTS:Two central themes emerged: (1) "Making sense of Suicidal Behaviours" captured the women's attempts to understand their actions, the overwhelming emotional pain they endured, and the internal struggle between life and death. (2) "Impact of Clinicians" reflected a profound loss of autonomy, with participants feeling controlled and monitored during their care. While some clinicians demonstrated empathy and provided support, others offered limited engagement, leaving participants feeling isolated and frustrated. CONCLUSION:While idiographic in scope (two cases), the study reflects well-recognised challenges recruiting from acute hospital settings and the impact of limited culturally safe services for Traveller communities. Findings underscore the importance of lived experience-informed, culturally safe, person-centred approaches that recognise the distinct challenges faced by Traveller women during suicidal crisis.
BACKGROUND:Suicide and domestic violence and abuse (DVA) represents a critical yet underexplored intersection of public health and social justice in Ireland. This study investigated the prevalence, circumstances, and risk factors associated with suicides with a recorded link to DVA drawing on coronial data from the Irish Probable Suicide Deaths Study (IPSDS 2015-2020). METHODS:All cases in the IPSDS (n = 3,622) were screened for documented domestic violence or related indicators. For selected cases, relevant demographic, clinical, psychosocial, and service-contact information was extracted and analysed using reflexive thematic analysis. Composite narratives were developed to synthesise recurrent patterns and present a "storied account" of the combined experiences across cases. RESULTS:Fifteen DVA-related suicide cases were identified; all were female. Thus, over the six-year period, 1.7% of suicides among adult women (≥18 years, n = 873) in Ireland were recorded as DVA-related. Multiple adverse experiences were identified among the women including mental health difficulties, substance misuse, physical health conditions, chronic pain, and unemployment. Together, these findings underscore the complexity of suicide prevention in this context. Composite narratives further illustrate how contextual and relational factors interact to shape suicide risk among women with experiences of DVA. CONCLUSION:Overlapping vulnerabilities and risk factors for women who die by DVA-related suicide present challenges for how "domestic violence" is identified and recorded in coronial records. Recommendations for service provision and the coronial system are discussed.
This Editorial introduces the Special Issue on Advance Decision-Making, Law and Mental Health. This Special Issue presents a wide range of empirical studies and perspective pieces from Irish and international authors on advance healthcare directives and other reforms in mental health and capacity law. It aims to harness an interdisciplinary approach to enrich our understanding of new legislation and how it can shape mental health practice in a person-centred way, while also tackling thorny conceptual and practical challenges in this area.
The primary purpose of this review is to compare the implementation of Balint groups (mandatory versus voluntary participation) in medical training, particularly for medical students and psychiatry trainees, and the accreditation pathways for Balint leaders across the United Kingdom (UK), the United States (USA), Ireland, Canada, and Germany. The review aims to highlight the rationales and implications of each model. A comparative literature review was conducted to evaluate existing approaches in the specified countries, drawing on national guidelines, society requirements, and relevant studies. The methods focused on identifying specific requirements set by governing bodies such as the Royal College of Psychiatrists (UK), the American Balint Society (ABS), the College of Psychiatrists of Ireland, and the German Medical Association. Data were handled by summarizing the variations in implementation and accreditation. Implementation varies significantly; the UK, Ireland, Canada, and Germany typically mandate some form of reflective group work for psychiatry trainees, linking it to progression or certification. Ireland and Germany have explicit session requirements, while the USA largely maintains a voluntary model. Accreditation pathways share core philosophies but differ in specific hour requirements, with European pathways being more rigorous than the portfolio-based models in the USA and Canada. The global trend recognizes a clinician's emotional awareness as crucial for effective patient care, pushing toward mandatory exposure to reflective group work in psychiatry training. To ensure consistency across diverse national Balint societies, the International Balint Federation could develop global minimum standards for participation and co-leadership to eliminate ambiguity.
Dual diagnosis (DD) refers to the coexistence in the same individual of a substance use disorder and other mental disorder. The increase in substance use among women over the past two decades, along with related health issues and mortality rates, has underscored the importance of integrating a gender-based approach in addiction research and treatment. This transition has led to an increased focus on substance use among women and individuals of other gender identities. This narrative review aims to examine the evidence on gender differences in DD to enhance knowledge that supports the development of innovative, evidence-based policies and practices. These efforts seek to improve access to and the adequate treatment of drug use disorders and comorbid conditions among women and LGBTQIA+ individuals. Additionally, advancements in the literature on epidemiology, clinical characteristics, environmental factors, treatment needs, and final recommendations are discussed. This manuscript supports a progression from gender integration towards gender transformation - a paradigm shift extending beyond the simple incorporation of gender perspectives into existing systems towards a deeper transformation that challenges and changes current gender norms and structures, aiming for a more equitable system.
BACKGROUND:Compulsive sexual behavior disorder (CSBD) was included in the ICD-11 as an impulse control disorder, yet pharmacological treatment options remain limited. Naltrexone, an opioid receptor antagonist approved for alcohol and opioid use disorders, has shown promise for compulsive sexual behaviors, though the extended-release injectable formulation has not been evaluated for this indication. CASE PRESENTATION:A 54-year-old married man with longstanding compulsive sexual behavior presented with acute symptom escalation following job loss, including compulsive pornography use, financial concealment, occupational impairment, and secondary depressive symptoms. Despite desvenlafaxine 50 mg and weekly psychotherapy incorporating motivational interviewing, cognitive-behavioral, and mindfulness-based techniques, he achieved inadequate symptomatic benefit. Extended-release naltrexone (Vivitrol) 380 mg intramuscular injection monthly was initiated as augmentation, chosen for more consistent receptor occupancy than oral formulations. Symptom severity was assessed using the Compulsive Sexual Behavior Inventory-13 (CSBI-13) and Hypersexual Behavior Inventory-19 (HBI-19) at baseline and monthly over three months. Hepatic function was monitored throughout. OUTCOMES:The patient demonstrated substantial improvement on both measures. CSBI-13 scores decreased from 65/65 at baseline to 25/65 at one month (61.5% reduction), stabilizing at 35/65 by month three (46.2% total reduction). HBI-19 scores decreased from 91/95 to 49/95 at one month (46.2% reduction), remaining stable at 47/95 through month three (48.4% total reduction). Liver enzymes remained within normal limits and no adverse events were reported. CONCLUSIONS:This case suggests extended-release naltrexone may be an effective augmentation strategy for CSBD unresponsive to antidepressant pharmacotherapy and psychotherapy. Controlled trials are needed to establish efficacy.
OBJECTIVES:Diagnostic criteria for attention deficit hyperactivity disorder (ADHD) and autism have broadened and are common at estimated adult prevalences of 3%. This paper explores the incidence of autism and overlap of features in ADHD young adults transitioning from Child and Adolescents Mental Health Services (CAMHS) into a specialist adult ADHD service, and the utility of the Ritvo Autism Asperger Diagnostic Scale 14 (RAADS-14) assisting assessment and support planning. METHODS:This comparative cohort study included all young adult ADHD patients referred from CAMHS. A comprehensive assessment and diagnostic formulation, including RAADS-14 was completed. Those without a current autism diagnosis but clinical assessment suggested autism, underwent further assessment. Percentage of autistic and ADHD young adults was calculated. RAADS-14 total and subscale scores were compared between groups. Gender differences were assessed. RESULTS:Co-occurrence of autism in a group of young adults diagnosed with ADHD was high (53%). High levels of autism features were evident in the ADHD only group. Significant differences in the RAADS-14 sub-scores (social anxiety, mentalizing and sensory sensitivities) were found between the autistic ADHD and non autistic ADHD groups. Autistic females scored higher on all domains of the RAADS-14 compared to males. Sensory sensitivities were significantly higher in females in both groups. CONCLUSIONS:The level of co-occurrence of autism, and overlap of features, suggests employment of neurodevelopmental rather than single condition approaches to avoid mis-diagnosis/missed diagnoses. Sensory sensitivities are suggestive of neurodevelopmental differences particularly in females regardless of diagnostic category. The RAADS-14 may be helpful as part of screening and support planning.
In recent years, global context has resulted in a growing number of forcibly displaced migrants (FDM) in Europe, including Ireland. Several factors can impact determinants of health, including traumatic experiences, resilience, and cultural background, along with local frameworks and accessibility to services. Interpreter availability, level of knowledge, and utilisation are of relevance to quality service provision, as is training and supervision. FDM are a vulnerable group; studies suggest higher rates of mental illness, but understanding this is complex. While community structures have been suggested to respond to specific needs, pathways to access secondary mental health services in Ireland can cause challenges and inequity. This review brings together relevant literature to conceptualise the topic and make recommendations for health professionals engaged in mental healthcare of FDM. Understanding professionals' perspectives, inclusion of people with lived experience, strong inter-agency collaboration, supervision, and training are some of the recommendations proposed.
INTRODUCTION:Despite being common and linked to significant morbidity and mortality, personality disorders (PD) are underdiagnosed. Stigma, professionals' therapeutic nihilism and lack of effective treatments are contributing factors. This survey aimed to explore the experiences of a service user group of being assessed for and receiving a diagnosis of personality disorder and to examine the impact of the diagnosis and the disorder on their life. METHODS:Patients under the care of two consultant-led teams who had received a diagnosis of personality disorder using Structured Clinical Interview for DSM-5 PD (SCID-5-PD) in 2019 and 2020 were invited by email to complete a qualitative survey. Responses were analysed using thematic analysis. RESULTS:Participants were predominantly aged 41-50 years, with most discharged over three years previously. Borderline personality disorder was most commonly reported. Thematic analysis identified three themes: Understanding and Being Understood - highlighting variable levels of comprehension and agreement with the diagnosis; A turning point - describing both abandonment and access to targeted treatment; and Restriction - capturing stigma, secrecy, and perceived negative impacts on care, relationships, and functioning. DISCUSSION:Findings highlight the complexity of delivering diagnoses in a meaningful and therapeutic way. Participants reported limited understanding, underscoring the need for clear, repeated psychoeducation and collaborative formulation while others described positive experiences leading to self understanding and recovery. Many were relieved to get the diagnosis after significant delays and lack of appropriate treatment. Revisiting formulation over time and linking diagnosis to treatment pathways appear crucial for acceptance, empowerment, and positive outcomes.
Borderline personality disorder (BPD) is a clinically significant and extensively studied personality disorder (PD), associated with substantial impairment, risk, treatment needs, and health-system burden. Contemporary debates about its classification now occur within diagnostic systems that already move beyond purely categorical models, including ICD-11 and the DSM-5 Alternative Model for Personality Disorders. The central question is therefore not simply whether dimensional assessment should be incorporated into PD diagnosis, but how general personality disorder diagnosis, named categorical patterns, dimensional characterization, and outcome/risk assessment should be clinically coordinated. This article examines BPD as a focal case for this broader categorical-dimensional problem. We review the clinical contributions and limitations of categorical and dimensional approaches, consider evidence supporting the reliability, validity, clinical utility, and treatment relevance of BPD, and propose a clinical sequencing model for PD assessment. The model is not intended as a new diagnostic architecture or diagnostic algorithm. Rather, it begins with establishing the presence of general personality disorder, then asks whether a named PD pattern is clinically meaningful, before proceeding to dimensional characterization and outcome/risk assessment. We argue that dimensional progress does not require the abandonment of named personality disorder diagnoses when they remain clinically and empirically meaningful. Within this framework, BPD can remain an organizing construct while categorical diagnosis is prevented from becoming the endpoint of clinical formulation.
BACKGROUND:Lewy body dementia (LBD), including Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), is common but under-recognised and poorly supported in the Irish healthcare system. This study evaluates the 'Mind and Movement Clinic' at St James's Hospital, Dublin, developed to address the needs of this population. OBJECTIVES:To analyse the demographic, cognitive, and neuropsychiatric profiles of 99 consecutive referrals and to map the care pathway for individuals with Parkinson's disease (PD), PD with mild cognitive impairment (PD-MCI), PDD, and DLB. METHODS:A cohort study of the first 99 referrals to the clinic was conducted, including clinical, demographic, cognitive, motor, and neuropsychiatric data. RESULTS:The sample included 36 individuals with PD-MCI, 9 with PD, and 48 with LBD (11 PDD, 37 DLB). Main referral reasons were cognitive impairment (64.65%), psychotic symptoms (30.30%), and affective symptoms (44.44%). LBD patients had significantly higher rates of hallucinations (75% vs. 26.7%) and delusions (31.25% vs. 4.44%) compared to those without dementia (p < 0.001). Medication interventions included cholinesterase inhibitors, antidepressants, and adjustments to dopaminergic therapy. Significant service needs were reflected in referrals to 16 different services. CONCLUSIONS:Patients with LBD have complex care requirements, supporting the need for a specialised service integrating memory and movement disorder care. Development of a core outcome set for LBD and an integrated care pathway, including post-diagnostic support, is recommended in the Irish context.
