Staff working in mental health services provide care for individuals with a variety of difficulties, which can pose treatment challenges. Perceived lack of progress in patients can engender uncomfortable feelings within the clinician, such as frustration, ‘heartsink’ and ‘feeling stuck’. The aim of this study was to explore the phenomenon of ‘feeling stuck’ amongst NCHDs in psychiatry.

A total of 30 participants were recruited from three psychiatric hospitals to complete a 15-item questionnaire. The survey was designed to pursue a thematic analysis. Participants were asked to complete the survey anonymously, either online or paper version. The analysis was carried out by two researchers using open coding, with themes finalised through collective discourse.

Three themes were elicited from the data. The central theme – ‘causes of feeling stuck’ – consisted of three subthemes (patient, doctor and system factors). Participants were adept at describing patient and system factors, but reflected on doctor factors, such as countertransference, less often and in less detail. Other themes, explored in less detail by respondents, were ‘the experience of feeling stuck’ and ‘responses to feeling stuck’, with participants tending to seek solutions to, rather than an understanding of, these feelings.

Trainee psychiatrists can clearly identify the situations where they are ‘stuck’ with clinical interactions. In spite of clinical supervision and reflective practice groups, they desire further training in managing these scenarios. NCHDs would benefit from further training, using these ‘stuck’ interactions as material, to further develop their understanding of the underlying factors in both themselves and their patients.

In Ireland, regularly reviewed Individual Care Plans (ICPs) for inpatients at all acute psychiatric inpatient units are a requirement of the Mental Health Act 2001. In this study, we comprehensively evaluated and compared opinions of key stakeholders in relation to the ICP as a care delivery tool.

We employed a descriptive survey design. Questionnaires were distributed to 123 stakeholders (patients and mental health professionals (MHPs)) to evaluate and compare opinions regarding the impact of the ICP in relation to healthcare delivery and health outcomes, and regarding the structure and frequency of use of the ICP.

Ninety-eight stakeholders (80%) completed study questionnaires. Stakeholders (patients (58%) and MHPs (85%)) reported that the ICP assisted in healthcare delivery. However, different attitudes between groups were noted in relation to whether the ICP contributed towards healthcare outcomes, with 64% of patients, but only 41% of MHPs reporting that the ICP positively contributed to mental healthcare outcomes. Some free-text comments described patient dissatisfaction with the role of the ICP for healthcare delivery, and MHP dissatisfaction that the ICP was time-consuming and did not significantly enhance standard patient care.

Whilst the implementation of the ICP is generally viewed positively by both patients and MHPs, considerable dissatisfaction by MHPs was also noted with certain aspects of how the ICP was delivered in practice. Practical adjustments to the implementation of ICP in order to build more positive stakeholder experiences appear warranted and worthy of further research.

The objective of this study was to understand the variables or study habits that inform study in undergraduate and postgraduate students attending Trinity College Dublin.

A descriptive, cross-sectional anonymous online survey was used to gather data to explore student study habits. Survey 1 was completed by participants in April 2019 and survey 2 was completed by participants in April 2020, during the COVID-19 restrictions.

A total of 1557 participants completed survey 1 in 2019, and 1793 participants completed survey 2 in 2020. In both surveys a majority reported using caffeine, library study, sleep pattern adjustment and excercise to aid academic performance. Survey 2 participants reported COVID-19 resulted in increased difficulty studying (91%). In particular loss of structure and routine was negatively impacted by the pandemic (92%), and increased feelings of stress were reported (75%).

Our study suggests a potential role of the college environment as a target for the implementation of interventions to promote student learning, healthy study habits and well-being. The global pandemic has resulted in additional challenging demands for universities to serve an essential role in supporting college students study habits.

This study provides data on the prevalence of mental health problems among adolescents in Ireland in 2021, toward the end of the COVID-19 pandemic. The importance of having recent, large-scale, mental health data for adolescents has been heightened by COVID-19, the increased demand for child and adolescent mental health services, and the rapidly changing adolescent environment.

As part of the Planet Youth study, a cross-sectional survey of adolescents (N = 4,404), mostly aged 15–16, was conducted between September and December 2021. Participants were recruited from 40 schools and non-traditional educational centres across 3 regions in Ireland, one predominantly urban (North Dublin) and two predominantly rural (Cavan, Monaghan). A range of mental health outcomes were self-reported: a single-item question on mental health; the Strengths & Difficulties Questionnaire (SDQ); depressive and anxiety symptoms from the Symptom Check List 90; the Adolescent Psychotic-like Symptom Screener; and lifetime self-harm, suicidal ideation, and attempt.

Over a quarter of adolescents described their mental health as ‘bad’ or ‘very bad’ (29%), and had SDQ total problem scores over 20 (26%). Over a third (39%) reported self-harming, 42% reported suicidal ideation, and 11% reported attempting suicide, in their lifetime. Gender-diverse youth (non-binary, trans, and undisclosed) had higher rates of poor mental health outcomes compared to cis-gendered youth (male/female), and females had higher rates of most mental health outcomes compared to males.

Many of these estimates suggest a deterioration from previous epidemiological studies. While our findings do not definitively prove youth mental health has worsened over time, these findings are highly concerning. We propose a close monitoring of mental health in future surveys of this population and encourage initiatives to improve the capacity and quality of youth mental health services.

As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation.

COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016.

During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder.

COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

The aim of the present study was to evaluate the levels of possible internet addiction, gaming addiction, gambling addiction and associated mental health difficulties in a secondary school population in Ireland.

An online survey containing questions related to internet addiction, gaming addiction, gambling addiction and associated mental health difficulties was administered to secondary school adolescents in Ireland. Participants were self-selecting and answered questions on the characteristics of each topic and screening questionnaires for addiction to each behaviour, as well as their respective effects on mental health.

A total of 234 children participated in the survey (156 males; aged 12–18 years; average age of 14.2 years; S.D. 1.60). Internet addiction as assessed using the Chen Internet Addiction Scale was present for between 11.5% and 22.6% and levels of gaming addiction as assessed using by the Internet Gaming Disorder Scale–Short Form was present for between 0.5% and 1.6%. Weak positive correlations were found between time spent on the internet and time spent gaming with internet addiction and gaming addiction, respectively. There were weak positive correlations between higher internet addiction scores, higher gaming addiction scores, and increased depression and anxiety scores. Using the South Oaks Gambling Screen–Revised for Adolescents, two participants were classed as ‘at-risk’ for gambling addiction and one participant was classed as a problem gambler.

The present study examined behavioural addictions and their effects on mental health on a self-selecting sample of schoolchildren at two schools in Ireland. A low number were identified as being at risk or problem gamblers.

To assess the prevalence of neuropsychiatric symptoms 2 years after the COVID-19 acute phase and to identify biobehavioral risk factors.

This 2-year prospective study assessed adult individuals with COVID-19 via face-to-face interview and laboratory testing at onset, and via telephone interview at 2-year follow-up. Data collected included COVID-19 severity and management at onset, as well as depression, anxiety, insomnia, cognitive failure, and fatigue at follow-up using standardized assessment tools.

Out of 1,067 screened COVID-19 patients, 230 completed the 2-year follow-up (female, 53.5%; aged>40, 80.9%; native Italian, 94.9%; medical comorbidity, 53.5%; chronic medication, 46.3%; moderate to severe COVID-19, 24.9%; hospital admission, 28.7%; ICU, 5.2%). At follow-up, 9.1% had anxiety, 11.3% depression, 9.1% insomnia, 18.3% cognitive failure, and 39.1% fatigue, of clinical relevance. Headache (OR = 2.49, 95% CI = 1.01–6.16, p = 0.048), dyspnea (OR = 2.55, 95% CI = 1.03–6.31, p = 0.043), and number of symptoms (OR = 1.23, 95% CI = 1.01–1.51, p = 0.047) at onset were associated with anxiety at follow-up; dyspnea at onset was associated with depression at follow-up (OR = 2.80, 95% CI = 1.22–6.41, p = 0.015); number of comorbidities at onset was associated with insomnia at follow-up (OR = 1.48, 95% CI = 1.06–2.08, p = 0.022); female gender (OR = 2.39, 95% CI = 1.14–5.00, p = 0.020) and number of symptoms (OR = 1.20, 95% CI = 1.02–1.42, p = 0.026) at onset was associated with cognitive failure at follow-up; number of comorbidities (OR = 1.33, 95% CI = 1.03–1.73, p = 0.029) and symptoms (OR = 1.19, 95% CI = 1.04-1.37, p = 0.013) and raised interleukin 6 levels (OR = 4.02, 95% CI = 1.42–11.36, p = 0.009) at onset was associated with fatigue at follow-up.

COVID-19 survivors, especially if female, with preexisting health problems, and with a more severe acute phase, may present with long-lasting neuropsychiatric sequalae, urging interventions to sustain recovery particularly in these higher risk individuals.

Despite proven effectiveness in refractory schizophrenia, clozapine remains underutilised, and it is important to understand potential reasons for this. This study’s aim was to examine in a National sample of Consultant Psychiatrists their knowledge of, attitudes and perceived barriers to clozapine use.

A novel questionnaire was designed and distributed by email to 275 Consultant Psychiatrists in Republic of Ireland.

Twenty-eight percent (n = 77) completed the survey, with 55% of respondents practicing for 15 or more years. Clinicians expressed confidence in managing clozapine treatment and side effects and were well aware of clozapine’s clinical effectiveness and guideline-based use. A majority indicated insufficient experience managing rechallenge and half expressed insufficient experience managing adverse events. Perceived patient factors were highlighted as barriers with 69% of respondents reporting patients’ concern about effectiveness and 50% regarding tolerability. Sixty-four percent (n = 40) indicated that a specialised/tertiary clozapine service would facilitate initiation, with 57% (n = 36) reporting less frequent blood monitoring would aid clozapine prescribing. A majority identified that access to dedicated staff (81%, n = 51) and dedicated day hospital services (84%, n = 53) would facilitate community initiation.

Consultants are familiar with clozapine use and related guidelines. Dedicated staff and facilities for clozapine use is one identified structural change to enhance clozapine prescribing in Ireland. Tertiary service or clinical advice service would assist in clozapine rechallenge cases or in managing significant adverse events. More structured patient education regarding clozapine effectiveness and professional development programmes focused on managing side effects and rechallenge may promote clozapine use.

This study aimed to identify risk and protective factors for mental health across student cohorts to guide mental health provision.

Cross-sectional data from the My World Survey 2-Post Second Level (MWS2-PSL) were used. The sample consisted of N = 9935 students (18–65 years) from 12 third-level institutions (7 out of 7 universities and 5 out of 14 Institute of Technologies (IoTs)) across Ireland. Key outcomes of interest were depression, anxiety and suicidality. Risk factors included drug/alcohol use, risky sexual behaviours and exposure to stressors. Protective factors included coping strategies, help-seeking, resilience, self-esteem, life satisfaction, optimism and social support. These factors were profiled by degree type (undergraduate, postgraduate taught, postgraduate research), access route, and institution type (IoT, university). Chi-square tests of Independence and one-way ANOVAs compared groups on key risk and protective factors.

A total 71% of respondents were female, 85% were aged 23 or under and there was a 2.2% response rate in IoTs versus 10.6% in university students. Undergraduates demonstrated higher levels of depression, anxiety, self-harm and suicidal ideation than postgraduates. Undergraduates showed higher risk and lower protective factors than postgraduates. Students attending Institutes of Technology reported higher levels of depression and anxiety, lower protective and higher risk factors than university students.

In this sample of students, undergraduates, especially those attending Institutes of Technology, were at increased risk of mental health difficulties. Findings suggest the need to tailor interventions to meet cohort needs, and consider the differing vulnerabilities and strengths across student cohorts. Due to limitations of this study, such as selection bias, further research is warranted.

Fluphenazine decanoate licenced as a long-acting injectable (LAI) first-generation antipsychotic (FGA) was withdrawn from sale in 2018. This study evaluates if its withdrawal resulted in increased relapse rates of psychosis in an Irish patient cohort and examines which prescribed alternative antipsychotic medications were associated with more optimal outcomes.

Fifteen participants diagnosed with a psychotic disorder were included. A mirror-image study over 24-months’ pre-and post-withdrawal of fluphenazine was conducted. Kaplan-Meier survival and proportional hazards analyses were conducted. The impact of alternate antipsychotic agents (LAI flupenthixol compared to other antipsychotic medications) was evaluated. Semi-structured interviews with participants examined subjective opinions regarding the change in their treatment.

Seven participants (46.7%) relapsed in the 24-month period subsequent to fluphenazine discontinuation compared to one individual (6.7%) in the previous identical time-period (p = 0.035). Flupenthixol treatment was associated with reduced relapse rates compared to other antipsychotics (χ2 = 5.402, p = 0.02). Thematic analysis revealed that participants believed that the discontinuation of fluphenazine deleteriously impacted the stability of their mental disorder.

The withdrawal of fluphenazine was associated with increased relapse rate in individuals previously demonstrating stability of their psychotic disorder. While acknowledging the limitation of small sample size, preliminary evidence from this study suggests that treatment with the first-generation antipsychotic (FGA) flupenthixol was associated with a lower risk of relapse compared to SGAs. Reasons for this lower risk of relapse are not fully clear but could be related to dopamine hypersensitivity with this treatment change.

The aim of the present study was to explore how adults who self-harm experience family relationships.

A phenomenological design was employed to examine the dynamic relationship between self-harm and family systems. Semi-structured interviews were conducted with six female adults who attend a community mental health service and engage in self-harm. Transcripts were analysed using Interpretative Phenomenological Analysis (IPA).

Four superordinate themes emerged from the data and two subordinate themes emerged within each superordinate theme: family interactive patterns (subordinate themes: enmeshed patterns and culture of ‘getting on with it’), searching for meaning (subordinate themes: expressing emotional turmoil and engrained worthlessness), relating to others (subordinate themes: guilt and feeling misunderstood) and journey towards life without self-harm (subordinate themes: acceptance and family support).

Findings emphasise the role of family systems in understanding self-harm in adults. The study highlights the need for family-based interventions for family members who support adults that self-harm.

To examine if the COVID-19 pandemic was associated with a differential effect longitudinally in relation to its psychological and functional impact on patients with bipolar disorder and Emotionally Unstable Personality Disorder (EUPD).

Semi-structured interviews were conducted with 29 individuals attending the Galway-Roscommon Mental Health Services with an ICD-10 diagnosis of either bipolar disorder (n = 18) or EUPD (n = 11). The impact of the COVID-19 pandemic was assessed in relation to anxiety and mood symptoms, social and occupational functioning, and quality of life utilising psychometric instruments and Likert scale data, with qualitative data assessing participants’ subjective experiences.

Individuals with EUPD exhibited significant anxiety and depressive symptoms and increased hopelessness compared to individuals with bipolar disorder. Repeated measures data demonstrated no significant change in symptomatology for either the EUPD or bipolar disorder group over time, but demonstrated an improvement in social (t = 4.40, p < 0.001) and occupational functioning (t = 3.65, p = 0.03), and in quality of life (t = 4.03, p < 0.001) for both participant groups. Themes attained from qualitative data included the positive impact of the discontinuation of COVID-19 mandated restrictions (n = 19), and difficulties experienced secondary to reductions in the provision of mental health services during the COVID-19 pandemic (n = 17).

Individuals with EUPD demonstrated increased symptomatology over a two-year period compared to those with bipolar disorder. The importance of face-to-face mental health supports for this cohort are indicated, particularly if future pandemics impact the delivery of mental health services.