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"Nutritional interventions in the field of psychiatry have been explored more intensively in the last two decades, but definitive conclusions based on the retrieved data in the literature about the efficacy of this therapeutic approach are difficult to formulate. This observation has multiple explanations, e.g., these therapeutic interventions are very heterogenous, cohort studies usually enroll different psychiatric populations or healthy subjects with minor psychiatric symptoms, nutritional supplements or special diets are commonly recommended as add-ons to the pharmacological interventions (thus making it difficult to differentiate the impact of each therapy on the outcomes), placebo-controlled randomized studies are still very few, etc. Therefore, a narrative review focused on the main challenges reported during the research in the field of nutritional psychiatry (NP) may be useful for clinicians interested in strategies to augment the efficacy of pharmacological treatments or to find new solutions with low risk of adverse events in patients with organic comorbidities or multiple concomitant medications. Data about the efficacy and tolerability of nutritional interventions explored for psychiatric disorders were searched in four electronic databases (PubMed, Cochrane, Clarivate/Web of Science, and EMBASE). Omega-3 polyunsaturated fatty acids supplementation, healthy diet interventions, folate and vitamin B12, S-adenosyl-L-methionine, N-acetyl cysteine, vitamin B1 and B6, vitamin D, minerals, psychobiotics, inositol, and herbal products were the main interventions identified, and their demonstrated efficacy was quite heterogenous, while their tolerability and safety were good. Therefore, NP is a domain of research that may benefit from more good-quality and longer-duration trials, in order to verify the effectiveness of such augmentation strategies to the already validated treatments."

The assessment of coping mechanisms in patients diagnosed with oncological diseases is essential for mental health
specialists, who have to design the most appropriate case management strategy for comorbid mood disorders, anxiety disorders,
adjustment disorders, and other psychiatric conditions that may be detected in this vulnerable population. The adequate
treatment of these disorders is important for the preservation of mental health status, quality of life, and overall functionality in
patients diagnosed with cancer. Coping mechanisms modulate the vulnerability toward psychiatric disorders, but they also have
an impact on treatment adherence, which is an important factor correlating with prognosis. Appraisal-focused, problem-focused,
emotion-focused, and occupation-focused coping represent the most well-defined strategies patients use when confronted with
a stressful life situation, like a diagnosis with potentially vital consequences. Maladaptive coping strategies may also be identified
in these patients, e.g., withdrawal from reality, including complete or partial denial of the disease, substance abuse, behavioral
addictions, refusal of the recommended treatment, etc. The psychotherapeutic approach in patients with oncological diseases
should include an initial evaluation of the coping strategies used either currently or in the past stressful conditions, an assessment
of all the psychosocial resources the patients have (e.,g., support group, professional insertion, hobbies), and screening for mood
and anxiety disorders that may have been triggered by the cancer diagnosis. Consequently, within the psychotherapeutic
framework, a trained specialist can enhance the role of adaptive coping strategies and highlight the disadvantages of
dysfunctional ones. This process may possess a favorable impact on treatment adherence, mental health status, and quality of
life in patients with cancer.

The care and management of mentally disordered offenders poses a major challenge to criminal justice agencies and psychiatric services. These patients, 'the people nobody owns', are particularly vulnerable to political and professional change and as psychiatric services become increasingly community-based, the task of meeting the needs of the offender, as well as expectations of public protection, becomes a more difficult prospect. This book brings together the papers and a summary of the discussion presented at a Cropwood Round Table conference organized by the Institute of Criminology and the Department of Psychiatry of the University of Cambridge. Seeking to define future needs and directions in legal and service provisions, it includes perspectives from the fields of criminology, sociology and social psychiatry, and contributions from practitioners and administrators. Remarkable for the tenacity and depth with which the expert contributors address the problems, this is essential reading for all professionals working in the psychiatric and criminal justice systems with this frequently marginalized client group. Through a searching examination of the situation within one jurisdiction it points the way to service developments, improved care management and research opportunities that have universal applications

Background: A large number of augmentation agents have been tried in patients with schizophrenia spectrum disorders, because negative and cognitive symptoms are difficult-to-treat with current pharmacological agents, and because the high percentage of treatment-resistant cases requires new therapeutic solutions. Inflammation is one of the supposed pathophysiological mechanisms in schizophrenia; therefore, antibiotics have been explored as add-on agents. No systematic review or meta-analysis about the efficacy of antibiotics in psychotic disorders has yet been conducted. Objectives: To assess if the use of antibiotics as add-on to current antipsychotic treatment may improve core symptoms of schizophrenia spectrum disorders, global clinical status, overall functionality, and if this augmentation strategy is well tolerated. Methods: A systematic literature review was conducted, including papers published between 1980 and 2018, which have been found in the main electronic databases (PubMed/MEDLINE, CINAHL, NCBI, Embase, Thomson Reuters/Web of Science). The keyword search strategy was formulated using the following paradigm: "schizophrenia spectrum disorders"/ "schizophrenia"/ "schizo-affective disorder"/ "schizophreniform disorder", AND "antibiotics"/ all the names of currently marketed antibiotics classes. This review was registered to PROSPERO database with the protocol number CRD42019119152. Results: Based on reviewing the selected trials regarding the efficacy of antibiotics over core symptoms of schizophrenia, only two agents were detected – minocycline and D-cycloserine. Minocycline as add-on to antipsychotic treatment was associated with mixed results, while regarding the efficacy of d-cycloserine either no significant difference, or superiority to placebo over negative and cognitive symptoms was reported. Minocycline had an overall effect over the clinical impression that was not distinguishable from placebo, although there was one trial supporting the efficacy of this antibiotic. The impact of minocycline over the global functioning when added to antipsychotic in patients with schizophrenia was mixed, with one positive and one negative trial (moderate to high quality designed trials). D-cycloserine had no significant impact over global clinical status or patients' overall functionality. Conclusion: From all the data reviewed and hierarchized resulted that larger trials are needed in order to confirm the efficacy of antibiotics as add-on to antipsychotics over negative and cognitive symptoms of schizophrenia spectrum disorders.

"The conundrum of post-psychotic depression (PPD) is still present in the psychiatric literature, for more than a century since it was first described by Mayer-Gross. After a short existence in the DSM-IV and ICD-10, this nosological construct was excluded from newer versions of the mental disorders classifications. Therefore, an exploratory analysis of the PPD concept was considered useful both from clinical and theoretical perspectives. There is a high prevalence of depressive symptoms in patients with schizophrenia spectrum disorders (SSD) and, although not all of them represent cases of PPD, they are considered risk factors for suicide. The arguments and contra-arguments for/against PPD were reviewed, and the potential pharmacological interventions for this disorder were analyzed. The explored evidence indicates that PPD is worth further investigation, and in order to differentiate it from schizoaffective disorder, negative symptoms of SSD, or depressive manifestations within the acute psychotic episodes, clearly defined criteria should be found. The use of validated scales, like the Calgary Depression Scale for Schizophrenia and the InterSePT Scale for Suicidal Thinking, is recommended for the initial assessment of depression and suicidal risk in patients with SSD, but also for their monitoring during the acute and maintenance phases. Besides the administration of combined, antidepressant and antipsychotic treatment, the use of clozapine, and the recommendation to initiate treatment for SSD with atypical antipsychotics whenever possible, there is a dearth of studies exploring specific interventions for PPD. Future studies are expected to address the validity of the nosological construct of PPD and the most adequate therapeutic and prophylactic interventions in patients with SSD."

Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the
shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual's sexual life but may also
contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process
and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach
is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes,
and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or
inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric,
psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The
results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales,
questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED
support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual
therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a
combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the
treatment to the patient's particularities.

Sixth Annual Report of the Independent Monitoring Group for A Vision for Change – the Report of the Expert Group on Mental Health Policy – July 2012 This is the 6th Annual Report of the Independent Monitoring Group for A Vision for Change (IMG) and the final report of the Second Group. It is clear to the IMG that the implementation of A Vision for Change (AVFC) to date including 2011 has been slow and inconsistent. There is a continued absence of a National Mental Health Service Directorate with authority and control of resources. Such a body has the potential to give strong corporate leadership and act as a catalyst for change. Click here to download HSE National and Regional Progress ReportsHSE – 6th Annual Report HSE – National and Regional Progress Report Progress Reports from Government DepartmentsDepartment of Children and Youth AffairsDepartment of Education and SkillsDepartment of Health Department of Justice and Equality Department of Social ProtectionDepartment of Environment, Community & Local Government National Mental Health Programme Plan Consultation Document What We Heard Submissions Received by the IMGAmnesty International Ireland submission Association of Occupational Therapists submission College of Psychiatry of Ireland submissionCollege of Psychiatry of Ireland – Press Release regarding Social Psychiatry and Recovery Conference College of Psychiatry of Ireland – regarding Psychotherapy Training for Psychiatric TraineesCollege of Psychiatry of Ireland – regarding relationship with Pharmaceutical Industry College of Psychiatry of Ireland – Mental Health in Primary CareDisability Federation of IrelandHealth Research Board submission Irish Association of Social Workers – Adult Mental Health Irish Association of Social Workers – Child and Adolescent Mental Health Irish College of General PractitionersMental Health CommissionMental Health ReformPharmaceutical Society of IrelandIrish Advocacy Network Childrens Mental Health CoalitionNational Disability AuthorityNational Service Users ExecutiveNational Service Users Executive – Second Opinions ReportNational Federation of Voluntary BodiesHeadstrong Â

"Neurocognitive disorders are extremely invalidating psychiatric disorders with chronic courses and significant negative impacts over all areas of cognitive functioning and behavioral activity. Although extensive research on these progressive neurodegenerative disorders has been conducted, pathogenetic treatments with long-term significant benefits are yet controversial. From a clinical perspective, there is an acute need to find therapeutic strategies that could delay cognitive impairment in patients diagnosed with Alzheimer's disease (AD), vascular dementia (VaD), Lewy body dementia (LBD), etc. Also, slowing the transition from mild cognitive impairment (MCI) to clinically significant AD is another important clinical aspect, with a major impact on the patient's daily functioning, quality of life, and caregivers' burden. Acetylcholinesterase inhibitors (AChEI) are still the first line of treatment in AD patients, and they are also administered in the case of VaD or Parkinson's dementia. Various nootropics have been studied in this population, as add-on agents. Highly purified animal tissue extracts (HPATE) are administered in patients with neurocognitive disorders due to their neurotrophic properties, but many questions remain unanswered regarding their pharmacodynamic characteristics. These extracts may be added to AChEI to enhance their pro-cognitive effect, but evidence to support the superior efficacity of this association versus AChEI monotherapy is mainly derived from low-to-medium quality clinical trials. In conclusion, HPATE may be a useful add-on to first-line pro-cognitive agents in AD and VaD, but larger trials with better methodology are needed. In particular cases, however, HPATE may be of significant interest for patients with mild-to-moderate AD, based on results from clinical practice."

Cannabinoids' usefulness in the treatment of neurological disorders (epilepsy, and various neurodegenerative diseases, such as Multiple Sclerosis and Alzheimer's Disease) has been demonstrated in a growing number of studies. Of the 11 known general types of natural cannabinoids, the focus has been mainly directed at cannabidiol (CBD) due to its specificity in stimulating cannabinoid receptors and the low rate of side effects, as well as on Δ (9)-tetrahydrocannabinol (Δ9-THC). The natural and synthetic analogs of CBD have been described as a potential treatment in neurological diseases, as they showed their therapeutic benefits in reducing the seizures from epilepsy and their neuroprotectivity in neurodegenerative diseases. First and foremost, CBD's neuroprotective properties are due to its capacity to act as an endogenous cannabinoid receptor agonist. Second, CBD enhances neuroprotection by interacting with many signal transduction pathways mediated indirectly through cannabinoid receptors. CBD also reduces the hyperphosphorylation of glycogen synthetase kinase 3 (GSK-3) induced by the buildup of Amyloid β in the physiopathology of Alzheimer's disease.

On cover: Department of the Army Technical manual TM 8-240, Department of the Air Force Manual AFM 160-42. ; Mode of access: Internet. ; 14

This study aimed to determine if: 1) C-reactive protein (CRP) level correlated with PTSD symptom severity as measured by PTSD Checklist-5 (PCL-5), and 2) ketone supplement reduced PTSD symptoms. Twenty participants with PTSD were randomly assigned to a ketone supplementation or placebo group and evaluated for 6-weeks for PTSD symptom severity and CRP levels. The Spearman Rank correlation between PCL-5 and CRP was positive, but not statistically significant. Mixed models on the ranks of the data were used to examine the difference in PCL-5 and CRP between ketone and control groups over time. Median PCL-5 at the pre-test was higher than at the post-test in the ketone group but not in the control. The reduction of PCL-5 medians between ketone and control groups at the post-test was not different. The median pre-test CRP was not different from than post-test in the ketone group or control group. This pilot study did not find a correlation between CRP levels and PTSD symptom severity but was limited by a lack of CRP data collection due to the loss of follow-up. PTSD symptom severity was not altered by 6 weeks of chronic ketone salt supplementation compared to the control group but should be examined in a larger sample size for further verification.

 Click here to download PDF 222KB Please scroll down for related documents  Related Documents: HSE National and Regional Progress Reports HSE – Key Deliverables 2009 – Report PDF 55KB HSE – National Report PDF 363KB HSE – Regional Report – Dublin Mid Leinster PDF 82KB HSE – Regional Report – Dublin North East PDF 89KB HSE – Regional Report – West PDF 91KB HSE – Regional Report -South PDF 152KB HSE Local Area Progress Reports HSE – Tipperay South PDF 395KB HSE – Tipperary North PDF 367KB HSE Sligo/Leitrim and West Cavan PDF 359KB HSE – Roscommon PDF 352KB HSE – Mayo PDF 338KB HSE – Louth/Meath PDF 525KB HSE – Limerick PDF 395KB HSE – Laois/Offaly PDF 366KB HSE – Kildare/West Wicklow PDF 317KB HSE – Galway West PDF 297KB HSE – Galway/Mayo and Roscommon Child and Adolescent PDF 59KB HSE – Galway East PDF 400KB HSE – Dun Laoghaire PDF 262KB HSE – Dublin West South West PDF 346KB HSE – Dublin South City PDF 361KB HSE – Dublin North PDF 371KB HSE – Dublin North West PDF 432KB HSE – Dublin North – Dublin Central & part of NW Dublin – Child and Adolescent PDF 53KB HSE – Dublin North Central PDF 341KB HSE – Donegal PDF 485KB HSE – Cork West PDF 424KB HSE – Cork South Lee PDF 469KB HSE – Cork North PDF 423KB HSE – Cavan/Monaghan PDF 371KB HSE – Carlow/Kilkenny PDF 451KB Progress Reports from Government Departments Department of Community Rural and Gaeltacht Affairs PDF 20KB Department of Education and Science PDF 121KB Department of Enterprise Trade and Employment PDF 25KB Department of Environment Heritage and Local Government PDF 47KB Department of Health and Children PDF 50KB Department of Justice Equality and Law Reform PDF 19KB Department of Social and Family Affairs PDF 27KB Submissions Received by the IMG Amnesty International Ireland submission PDF 87KB Association of Occupational Therapists submission PDF 81KB College of Psychiatry of Ireland submission PDF 21KB Disability Federation of Ireland submission PDF 81KB Health Research Board submission PDF 24KB Inclusion Ireland submission PDF 18KB Independent Mental Health Sevice Providers submission PDF 82KB Irish Association of Consultants in Psychiatry of Old Age submission PDF 37KB Irish College of General Practitioners submission PDF 25KB Irish Hospital Consultancts Association submission PDF 155KB Irish Medical Organisation submission PDF 63KB Irish Mental Health Coalition submission PDF 90KB Mental Health Commission submission PDF 64KB Mental Health Nurse Managers submission PDF 206KB National Council for the Professional Development of Nursing and Midwifery submission PDF 67KB National Disability Authority submission PDF 49KB National Service Users Executive submission PDF 28KB Neurobehaviour Clinic – National Rehabilitation Hospital submission PDF 24KB Neurological Alliance of Ireland submission PDF 20KB

Opioid use disorder is a worldwide challenge for an increasing number of patients, and still the therapeutic options presented in clinical guidelines for this condition are very few. The first line pharmacological therapies for opioid use disorder continue to be opioid agonists as substitution treatment, but the need to find new treatments without the effect of prolonging opioid dependence become more and more obvious. This systematic review presents the most supported by evidence pharmacological agents that can be used as monotherapy for opioid use disorder patients (i.e., naltrexone, extended release/implant and oral formulation), or as adjuvants to substitution therapy (e.g. olanzapine for aggressive behaviours, memantine or dextromethorphan for reducing inflammatory processes related to opioid use). More good quality data derived from larger, well designed trials are needed in order to find solid recommendations for non-opioid agonists in the treatment of opioid use disorder.

"Artificial Intelligence (AI) systems are increasingly being developed and various applications are already used in medical practice. This development promises improvements in prediction, diagnostics and treatment decisions. As one example, in the field of psychiatry, AI systems can already successfully detect markers of mental disorders such as depression. By using data from social media (e.g. Instagram or Twitter), users who are at risk of mental disorders can be identified. This potential of AI-based depression detectors (AIDD) opens chances, such as quick and inexpensive diagnoses, but also leads to ethical challenges especially regarding users' autonomy. The focus of the presentation is on autonomy-related ethical implications of AI systems using social media data to identify users with a high risk of suffering from depression. First, technical examples and potential usage scenarios of AIDD are introduced. Second, it is demonstrated that the traditional concept of patient autonomy according to Beauchamp and Childress does not fully account for the ethical implications associated with AIDD. Third, an extended concept of "Health-Related Digital Autonomy" (HRDA) is presented. Conceptual aspects and normative criteria of HRDA are discussed. As a result, HRDA covers the elusive area between social media users and patients. "