Quality of life after involuntary psychiatric admission.

Studies seeking predictors of outcomes after involuntary admission, including quality of life (QoL), are limited and results inconsistent. We aimed to describe QoL 3 months after involuntary psychiatric admission and to investigate associated factors. One hundred and fifty-three involuntarily admitted inpatients were assessed for a range of sociodemographic and clinical variables. Structured scales included the Brief Psychiatric Rating Scale (BPRS), the MacArthur Admission Experience Survey, the Heinrichs Quality of Life Scale and the World Health Organisation Quality of Life Brief Assessment (WHOQOL-BREF, n = 124). The mean total score on the Heinrichs QoL scale at 3 months was 69.3 (SD = 24.1). Predictors of higher 3 month QoL after involuntary admission in a multiple regression model (adjusted R2 = 0.37, F = 7.1 (14, 138), p ≤0.001) were less severe negative symptoms on the BPRS at baseline (B = -4.56, p < 0.001), improvement in negative symptom scores between baseline and follow up (B = 4.58, p < 0.001) and higher current social class (B = -14.31, p = 0.001). Events during involuntary admission, such as being subject to coercive experiences, were not significantly associated with QoL after admission. The results suggest that a core determinant of service users' QoL after involuntary admission is negative symptom severity and change over time.

Opinions of key stakeholders concerning involuntary admission of patients under the Mental Health Act 2001.

OBJECTIVES: To evaluate and compare the opinions of key stakeholders involved in the involuntary admission and treatment of patients under the Mental Health Act (MHA) 2001 regarding their views towards the operation of the legislation. METHODS: We employed a descriptive survey design. A questionnaire was distributed to stakeholders involved in the operation of the MHA 2001 (except service users, whose views were explored in a separate qualitative study) via paper or online versions evaluating their opinions regarding the operation of the MHA 2001 in relation to assessment, care, rights, transfer and information available. RESULTS: Stakeholders agreed that in their opinion that patients generally benefit from the care they receive (79%) and that the MHA 2001 ensures an independent and fair review of the person's detention (65%). However, only 23% of stakeholders were satisfied with the process of transferring patients to hospital and with the clinical assessment procedures therein (37%), with the greatest levels of dissatisfaction amongst Gardai (Police), general practitioners (GPs) and family members. CONCLUSIONS: While the introduction of the MHA 2001 has assisted delivery of care to patients with improved adherence to international human rights frameworks applicable at the time of its enactment, substantial dissatisfaction with the implementation of the MHA 2001 in practice is experienced by stakeholders particularly at the distressing phase of clinical assessment and transfer to hospital.

Service users' experiences of mental health tribunals in Ireland: a qualitative analysis.

OBJECTIVES: To explore the mental health tribunal experiences of people admitted involuntarily under the Mental Health Act 2001. METHODS: Employing a qualitative descriptive study design, data were collected from 23 service users who had experienced mental health tribunals during a recent involuntary admission. Face-to-face semi-structured interviews were conducted ~3 months post-revocation of their involuntary admission order. Data were analysed using an inductive thematic process. RESULTS: The majority of participants reported mixed experiences comprising positive and negative aspects in relation to information provision, emotional support and an inclusive atmosphere. Some participants reported receiving accessible information about the tribunal process, felt emotionally supported throughout, and encountered respectful and dignifying practices during the tribunal proceedings. However, many participants described experiencing non-inclusive practices, reported feeling ill-informed regarding the tribunal process, emotionally unsupported during and after the tribunal, and distressed by what they perceived as adversarial tribunal proceedings. CONCLUSIONS: Systemic changes could ensure that the positive experiences encountered by the minority of participants in this study are more consistently experienced. Ongoing education and training of stakeholders in the provision of inclusive tribunal practices, and the provision of accessible information and emotional support to service users through the stages of the involuntary admission process appear likely to be beneficial. Service users should automatically be offered the option of having a support person of their choosing present during tribunals.

Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001.

Introduction We present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available. METHOD: Case Report. CONCLUSION: The case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.

Gastro-oesophageal reflux in pregnancy. Altered function of the barrier to reflux in asymptomatic women during early pregnancy.

The object of this study was to investigate the effect of early pregnancy on the competence of the barrier to gastro-oesophageal reflux (GOR). Oesophageal manometry and prolonged intra-oesophageal pH monitoring were carried out in 12 asymptomatic pregnant women and in 7 non-pregnant women. There was no significant difference in mean intragastric pressure between these two groups. However, both mean lower oesophageal sphincter (LOS) pressure and mean barrier pressure (LOS pressure minus intragastric pressure) were significantly lower in the pregnant subjects (16.9 +/- 0.79 mm Hg; 8.69 +/- 0.73 mm Hg) than in the controls (21.5 +/- 1.93 mm Hg; 14.1 +/- 1.22 mm Hg) (p less than 0.01 and less than 0.001, respectively). No significant difference could be demonstrated between the two groups with regard to degree of GOR, although the pregnant women did exhibit a tendency towards more marked reflux. The results indicate a diminution in the barrier to reflux in early pregnancy due to a reduction in LOS pressure, which may be the basis of symptomatic GOR in pregnancy.

Some changing aspects of primary hyperparathyroidism.

Ninety eight patients who underwent cervical exploration for primary hyperparathyroidism are reviewed. The detection of this condition in increasing numbers of patients, particularly those with minimal or no symptoms is confirmed. Initial exploration was successful in 92 cases using visual localisation with immediate frozen section examination of any presumed parathyroid tissue. The high incidence of solitary adenomata (84%) and low rate of recurrent hypercalcaemia support a "conservative" surgical approach as opposed to routine sub-total parathyroidectomy. The most common complication of surgery was hypocalcaemia, which is preventable by avoiding routine exhaustive exploration for, and unnecessary biopsy of, normal glands.

Inflammatory aneurysms of the abdominal aorta with associated ureteric obstruction or medial deviation.

Six cases of ureteric involvement in the retroperitoneal fibrosis associated with inflammatory aneurysms of the abdominal aorta are described. Though of uncertain aetiology, such aneurysms appear to constitute a distinct disease entity. The treatment of choice of an inflammatory aneurysm with ureteric obstruction is aneurysmectomy and ureterolysis. In unfit patients, ureterolysis alone or the administration of steroids is indicated. Pre-operative diagnosis of aneurysms of the inflammatory type may be possible with the aid of intravenous urography and erythrocyte sedimentation rate determination. The value of ultrasonography and computed tomography in diagnosis is still to be proven. Some modification of the standard technique of aneurysmectomy may be necessary when other retroperitoneal structures have been rendered inseparable from the aortic wall due to their involvement in the dense inflammatory fibrous reaction.

Primary hyperparathyroidism due to overactive intrathyroid parathyroid glands: a potential cause of failed exploration.

The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.

Hypoxaemia after left thoracotomy for benign oesophageal disease.

Arterial blood gases were measured before and after operation in 14 patients undergoing conservative oesophageal surgery via a left thoracotomy. All the patients had a preoperative partial pressure of oxygen (PO2) of greater than 10 kPa, and none gave a history of chronic respiratory disease. All exhibited a fall in PO2 values after operation, the mean maximum reduction being 31%. The overall pattern of hhypoxaemia was similar to that previously reported after pulmonary resection, and upper abdominal surgery, characterised by the greatest reduction in PO2 on the first two postoperative days, followed by a gradual return towards preoperative values. In addition, there was a marked similarity in the degree of hypoxaemia observed by Parfey et al and by ourselves. These findings are attributed to similar changes occurring in pulmonary function in both series of patients, caused at least in part by different factors associated specifically with the two surgical approaches involved. In our experience, left thoracotomy, even without pulmonary resection, is associated with significant postoperative hypoxaemia. Knowledge of this may assist in the selection of patients for surgery and in their subsequent management.

Angiomatous lymphoid hamartoma of the pelvis.

A mass removed from the pelvic retroperitoneal tissues of a 24-year-old women was found to be an angiomatous lymphoid hamartoma. The clinical, radiological and histological features are described, and the problems encountered in diagnosis discussed.