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O’Reilly K, Donohoe G, O’Sullivan D, Coyle C, Corvin A, O’Flynn P, O’Donnell M, Galligan T, O’Connell P, Kennedy HG. A randomized controlled trial of cognitive remediation for a national cohort of forensic patients with schizophrenia or schizoaffective disorder. BMC Psychiatry 2019; 19:27. [PMID: 30646884 PMCID: PMC6334394 DOI: 10.1186/s12888-019-2018-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 01/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence is accumulating that Cognitive Remediation Training (CRT) is effective for ameliorating cognitive deficits experienced by patients with schizophrenia and accompanying functional impairment. There has been no randomized controlled trial of CRT using a nationally representative population of forensic patients, despite the significant cognitive deficits frequently present within this group. METHODS Sixty-five patients with schizophrenia or schizoaffective disorder were enrolled in a single blind randomized controlled trial of CRT versus treatment as usual (TAU); representing 94% of those eligible within a national forensic cohort. The primary outcome measure was the composite score of the MATRICS Consensus Cognitive Battery (MCCB). Secondary outcome measures included neurocognitive and social cognitive domains, symptoms, and 'real world' functioning. Patient satisfaction was examined using an exit interview. Participants were reassessed at 8 months follow up. All data were analyzed using an intention to treat design (ITT). RESULTS For the primary outcome measure, the MCCB composite score, there were significant differences between those who participated in CRT and those receiving TAU at both end of treatment and 8 months follow up (Cohen's d = 0.34. Significant improvements were observed in visual and working memory. Mediation analysis found that those who cognitively benefited from CRT had corresponding improved functioning, and more net positive therapeutic moves i.e. moves to units with lower security within the hospital. Ninety-six percent believed their cognitive gains positively affected their daily lives. CONCLUSIONS CRT may be an acceptable and efficacious intervention for forensic patients with schizophrenia or schizoaffective disorder. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02360813 . Trial registered Feb 4th 2015, last updated May 1st 2015.
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Affiliation(s)
- Ken O’Reilly
- 0000 0004 1936 9705grid.8217.cDepartment of Psychiatry Trinity College Dublin, the University of Dublin, Dublin, Ireland ,0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Gary Donohoe
- 0000 0004 0488 0789grid.6142.1School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Danny O’Sullivan
- 0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Ciaran Coyle
- 0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Aiden Corvin
- 0000 0004 1936 9705grid.8217.cDepartment of Psychiatry Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Padraic O’Flynn
- 0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Muireann O’Donnell
- 0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Toni Galligan
- 0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Paul O’Connell
- 0000 0004 1936 9705grid.8217.cDepartment of Psychiatry Trinity College Dublin, the University of Dublin, Dublin, Ireland ,0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
| | - Harry G. Kennedy
- 0000 0004 1936 9705grid.8217.cDepartment of Psychiatry Trinity College Dublin, the University of Dublin, Dublin, Ireland ,0000 0004 0616 8533grid.459431.eThe Central Mental Hospital, National Forensic Mental Health Service Ireland, Dublin, Ireland
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Richter MS, O’Reilly K, O’Sullivan D, O’Flynn P, Corvin A, Donohoe G, Coyle C, Davoren M, Higgins C, Byrne O, Nutley T, Nulty A, Sharma K, O’Connell P, Kennedy HG. Prospective observational cohort study of 'treatment as usual' over four years for patients with schizophrenia in a national forensic hospital. BMC Psychiatry 2018; 18:289. [PMID: 30195335 PMCID: PMC6129297 DOI: 10.1186/s12888-018-1862-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 08/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND We evaluated change in response to multi-modal psychosocial 'treatment as usual' programs offered within a forensic hospital. METHODS Sixty nine patients with a diagnosis of schizophrenia or schizoaffective disorder were followed for up to four years. Patient progress was evaluated using the DUNDRUM-3, a measure of patient ability to participate and benefit from multi-modal psychosocial programs and the HCR-20 dynamic items, a measure of violence proneness. We report reliable change index (RCI) and reliable and clinically meaningful change (RMC). We assessed patients' cognition using the MCCB, psychopathology using the PANSS. The effect of cognition and psychopathology on change in DUNDRUM-3 was examined using hierarchical multiple regression with age, gender, and baseline DUNDRUM-3 scores. RESULTS The DUNDRUM-3 changed significantly (p < 0.004, d = 0.367, RCI 32% of 69 cases, RMC 23%) and HCR-20-C (p < 0.003, d = 0.377, RCI 10%). Both cognition and psychopathology accounted for significant variance in DUNDRUM-3 at follow up. Those hospitalized for less than five years at baseline changed more than longer stay patients. Mediation analysis demonstrated that the relationship between cognition and change in violence proneness (HCR-20-C) was both directly affected and indirectly mediated by change in DUNDRUM-3. CONCLUSIONS Change in response to multi-modal psychosocial programs (DUNDRUM-3) reduced a measure of violence proneness over four years. Forensic in-patients' ability to benefit from psychosocial treatment appears to be a function of the outcome measure used, unit of measurement employed, degree of cognitive impairment, psychopathology, and length of stay. Lower risk of re-offending may be partially attributable to participation and engagement in psychosocial interventions.
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Affiliation(s)
- Melanie S. Richter
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychology, Maastricht University, Maastricht, The Netherlands
| | - Ken O’Reilly
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Danny O’Sullivan
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Padraic O’Flynn
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Aiden Corvin
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Gary Donohoe
- Department of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ciaran Coyle
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Mary Davoren
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Caroline Higgins
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Orla Byrne
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Tina Nutley
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Andrea Nulty
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Kapil Sharma
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Paul O’Connell
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - Harry G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
- Department of Psychiatry, Trinity College, Dublin, Ireland
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Moynihan G, O’Reilly K, O’Connor J, Kennedy HG. An evaluation of functional mental capacity in forensic mental health practice: the Dundrum capacity ladders validation study. BMC Psychiatry 2018; 18:78. [PMID: 29580216 PMCID: PMC5870220 DOI: 10.1186/s12888-018-1658-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/09/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Because of the potential gravity of finding a person incompetent, assessment of mental capacity is challenging for clinicians. We aimed to test validity of a new structured professional judgement tool designed to assess functional mental capacity in three domains - finances, welfare and healthcare. METHODS Fifty-five male forensic psychiatric patients with Schizophrenia were interviewed using the Dundrum Capacity Ladders - a new semi-structured interview, and scores were assigned on a stratified scoring system, measuring ability to understand, reason, appreciate the personal importance of the decision at hand and communicate a decision. Data were also gathered pertaining to level of therapeutic security at the time of interview, diagnosis, neurocognitive function and a validated measure of real world function. RESULTS The results show that internal consistency and inter-rater reliability were high for all items. There were correlations between higher scores of functional mental capacity, neurocognitive function and measures of real world function in this population. Correlations were in the range 0.358 to 0.693, effect sizes that were moderate to high. CONCLUSIONS The DUNDRUM Capacity Ladders appear to be a valid measure of functional mental capacity in this population. Further prospective studies of functional mental capacity as a measure of recovery are now required.
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Affiliation(s)
- Gearoid Moynihan
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Ken O’Reilly
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Jane O’Connor
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Harry G. Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
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O’ Flynn P, O’ Regan R, O’ Reilly K, G Kennedy H. Predictors of quality of life among inpatients in forensic mental health: implications for occupational therapists. BMC Psychiatry 2018; 18:16. [PMID: 29351784 PMCID: PMC5775562 DOI: 10.1186/s12888-018-1605-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Padraic O’ Flynn
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Roisin O’ Regan
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland
| | - Ken O’ Reilly
- 0000 0004 0616 8533grid.459431.eNational Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland ,0000 0004 1936 9705grid.8217.cDepartment of Psychiatry, Trinity College, Dublin, Ireland
| | - Harry G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin, Ireland. .,Department of Psychiatry, Trinity College, Dublin, Ireland.
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O'Reilly K, O'Connell P, Donohoe G, Coyle C, O'Sullivan D, Azvee Z, Maddock C, Sharma K, Sadi H, McMahon M, Kennedy HG. Anticholinergic burden in schizophrenia and ability to benefit from psychosocial treatment programmes: a 3-year prospective cohort study. Psychol Med 2016; 46:3199-3211. [PMID: 27576609 DOI: 10.1017/s0033291716002154] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Many medications administered to patients with schizophrenia possess anticholinergic properties. When aggregated, pharmacological treatments may result in a considerable anticholinergic burden. The extent to which anticholinergic burden has a deleterious effect on cognition and impairs ability to participate in and benefit from psychosocial treatments is unknown. METHOD Seventy patients were followed for approximately 3 years. The MATRICS consensus cognitive battery (MCCB) was administered at baseline. Anticholinergic burden was measured with the Anticholinergic Cognitive Burden (ACB) scale. Ability to benefit from psychosocial programmes was measured using the DUNDRUM-3 Programme Completion Scale (D-3) at baseline and follow-up. Psychiatric symptoms were measured using the PANSS. Total antipsychotic dose was measured using chlorpromazine equivalents. Functioning was measured using the Social and Occupational Functioning Assessment Scale (SOFAS). RESULTS Mediation analysis found that the influence of anticholinergic burden on ability to participate and benefit from psychosocial programmes was completely mediated by the MCCB. For every 1-unit increase on the ACB scale, change scores for DUNDRUM-3 decreased by -0.27 points. This relationship appears specific to anticholinergic burden and not total antipsychotic dose. Moreover, mediation appears to be specific to cognition and not psychopathology. Baseline functioning also acted as mediator but only when MCCB was not controlled for. CONCLUSIONS Anticholinergic burden has a significant impact on patients' ability to participate in and benefit from psychosocial treatment programmes. Physicians need to be mindful of the cumulative effect that medications can have on patient cognition, functional capacity and ability to benefit from psychosocial treatments.
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Affiliation(s)
- K O'Reilly
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - P O'Connell
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - G Donohoe
- Department of Psychology,National University of Ireland,Galway,Ireland
| | - C Coyle
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - D O'Sullivan
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - Z Azvee
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - C Maddock
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - K Sharma
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - H Sadi
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - M McMahon
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
| | - H G Kennedy
- National Forensic Mental Health Service, Central Mental Hospital,Dundrum,Dublin,Ireland
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