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Meehan S, Moran S, Rainford A, McDonald C, Hallahan B. The impact of fluphenazine withdrawal: a mirror-image study. Ir J Psychol Med 2024:1-5. [PMID: 38497092 DOI: 10.1017/ipm.2024.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Fluphenazine decanoate licenced as a long-acting injectable (LAI) first-generation antipsychotic (FGA) was withdrawn from sale in 2018.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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- S Meehan
- School of Medicine, University of Galway, Galway, Ireland
| | - S Moran
- School of Medicine, University of Galway, Galway, Ireland
| | - A Rainford
- School of Medicine, University of Galway, Galway, Ireland
| | - C McDonald
- School of Medicine, University of Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- School of Medicine, University of Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
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Nikkhah A, Hallahan B, McDonald C. Opinions of key stakeholders regarding the inpatient Individual Care Plan. Ir J Psychol Med 2024; 41:11-22. [PMID: 33966680 DOI: 10.1017/ipm.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES In Ireland, regularly reviewed Individual Care Plans (ICPs) for inpatients at all acute psychiatric inpatient units are a requirement of the Mental Health Act . In this study, we comprehensively evaluated and compared opinions of key stakeholders in relation to the ICP as a care delivery tool. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- A Nikkhah
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Fitzgerald N, Moylett E, Gaffney G, McCarthy G, Fapohunda O, Murphy AW, Geoghegan R, Hallahan B. Undertaking a face-to-face objective structured clinical examination for medical students during the COVID-19 pandemic. Ir J Psychol Med 2024; 41:61-67. [PMID: 35575056 DOI: 10.1017/ipm.2022.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND AIMS Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students' satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic. MATERIALS AND METHODS This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE. RESULTS The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry (p = 0.001), paediatrics (p = 0.001) and general practice (p < 0.001) with more students attaining honours grades (χ2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%). CONCLUSION This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.
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Affiliation(s)
- N Fitzgerald
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - E Moylett
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Paediatrics, University Hospital Galway, Ireland
| | - G Gaffney
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Obstetrics and Gynaecology, University Hospital Galway, Ireland
| | - G McCarthy
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Sligo-Leitrim Mental Health Services, Sligo University Hospital, Ireland
| | - O Fapohunda
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Otolaryngology, University Hospital Galway, Ireland
| | - A W Murphy
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of General Practice, National University of Ireland, Galway, Ireland
| | - R Geoghegan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Department of Paediatrics, University Hospital Galway, Ireland
| | - B Hallahan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
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Mannix D, Holleran L, Cevikel P, McMorrow C, Nerney D, Phelan S, McDonald C, Hallahan B. A comparison of rate and methods of probable suicide for 2 years pre and post the onset of the COVID-19 pandemic. Ir J Psychol Med 2024:1-6. [PMID: 38229585 DOI: 10.1017/ipm.2023.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
OBJECTIVES To examine and compare rates and methods of probable suicide in a Western region of Ireland during a 24 month period since the onset of the COVID-19 pandemic compared with a similar period immediately prior to the pandemic onset. METHODS Post-mortem reports between March 1st 2018 and February 29th 2020 were reviewed and compared with data from March 1st 2020 to February 28th 2022. Relevant demographic data, rates and methods of probable suicide and lifetime engagement with mental health services were compared across the two time points. RESULTS Identical rates of probable suicide (85 individuals at both time points) were demonstrated with no difference evident in the utilisation of violent compared to non-violent methods. CONCLUSIONS This study demonstrates that despite previous reports of increased rates of self-harm and some evidence of increased mental distress since the onset of the COVID-19 pandemic, no change in rates of or methods employed by individuals who died by probable suicide were evident in this geographical region.
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Affiliation(s)
- D Mannix
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - L Holleran
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - P Cevikel
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - C McMorrow
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - D Nerney
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - S Phelan
- Department of Pathology, University College hospital Galway, Galway, Ireland
| | - C McDonald
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - B Hallahan
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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O'Malley A, McIntyre A, McGilloway A, Doherty A, Hallahan B. The impact of the COVID-19 pandemic on presentations of self-harm over an 18-month period to a tertiary hospital. Ir J Psychol Med 2023; 40:418-423. [PMID: 36794350 DOI: 10.1017/ipm.2023.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES To examine and compare rates and methods of self-harm presenting to a tertiary referral hospital during an 18-month period since the onset of the COVID-19 pandemic with a similar period immediately prior to the pandemic onset. METHODS Data from an anonymized database compared rates of self-harm presentations and methods employed between 1st March 2020 and 31st August 2021 to a similar time-frame prior to the onset of the COVID-19 pandemic. RESULTS A 9.1% increase in presentations with self-harm was noted since the onset of the COVID-19 pandemic. Periods of more stringent restrictions were associated with higher levels of self-harm (daily rate of 2.10 v 0.77). A higher lethality of attempt was demonstrated post-COVID-19 onset (χ2 = 15.38, p < 0.001). Fewer individuals presenting with self-harm were diagnosed with an adjustment disorder since the onset of the COVID-19 pandemic (n = 84, 11.1%, v. n = 112, 16.2%, χ2 = 7.898, p = 0.005), with no other differences pertaining to psychiatric diagnosis noted. More patients actively engaged with mental health services (MHS) presented with self-harm (n = 239 (31.7%) v. n = 137, (19.8%), χ2 = 40.798, p ≤ 0.001) since the onset of the COVID-19 pandemic. CONCLUSIONS Despite an initial reduction, an increase in rates of self-harm has occurred since the onset of the COVID-19 pandemic with higher rates evident during periods of higher government mandated restrictions. An increase in active patients of MHS presenting with self-harm potentially relates to reduced availability of supports and particularly group activities. The recommencement of group therapeutic interventions for individuals attending MHS in particular is warranted.
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Affiliation(s)
- A O'Malley
- School of Medicine, University of Galway, Galway, Ireland
| | - A McIntyre
- School of Medicine, University of Galway, Galway, Ireland
| | - A McGilloway
- School of Medicine, University of Galway, Galway, Ireland
| | - A Doherty
- Department of Psychiatry, University College Dublin, Dublin, Ireland
- Department of Psychiatry, Mater Hospital, Dublin, Ireland
| | - B Hallahan
- School of Medicine, University of Galway, Galway, Ireland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
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McLoughlin A, Mulholland K, McMahon E, Plunkett R, Hennigan K, McDonald C, Hallahan B. A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders. Ir J Psychol Med 2023; 40:437-444. [PMID: 37051901 DOI: 10.1017/ipm.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To examine if the COVID-19 pandemic is associated with a differential effect over a 2-year time period in relation to its psychological and social impact on patients with established anxiety disorders. METHODS Semi-structured interviews were conducted with 21 individuals attending the Galway-Roscommon Mental Health Services in Ireland with an ICD-10 diagnosis of an anxiety disorder. Interviews occurred at three time-points over a 2-year period to determine the impact of the COVID-19 pandemic and associated restrictions on anxiety and depressive symptoms, social and occupational functioning, and quality of life. RESULTS No statistical difference in symptomatology was noted between the three time-points in relation to anxiety symptoms as measured utilising psychometric rating scales (Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HARS) or Likert Scale measures). The greatest impact of COVID-19 at all time-points related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted a tentative optimism for the future in the setting of vaccination and societal re-opening. Fear of re-emerging anxiety symptoms with the removal of societal restrictions was noted. CONCLUSIONS No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders, however variability was demonstrated, with some individuals describing ongoing anxiety, social isolation and concern for their future. A strong theme of hope for the future and less concern regarding the COVID-19 pandemic was evident; however tailored supports including the utilisation of tele-psychiatry is suggested, particularly for those experiencing increased anxiety with the removal of societal restrictions.
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Affiliation(s)
- A McLoughlin
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
- Department of Psychiatry, Jonathan Swift Centre, St. James's Hospital, Dublin8, Ireland
| | - K Mulholland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
| | - E McMahon
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
| | - R Plunkett
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
- Department of Psychological Medicine, St. James's Hospital, Dublin8, Ireland
| | - K Hennigan
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
- Department of Psychiatry, Mayo University Hospital, Castlebar, Co. Mayo, Ireland
| | - C McDonald
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
| | - B Hallahan
- Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
- School of Medicine, University of Galway, Galway, Ireland
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7
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Mulholland K, McLoughlin A, McDonald C, Hallahan B. Kynanthropic and vampirism delusions: a case report and review of the literature. Ir J Psychol Med 2023:1-4. [PMID: 37409488 DOI: 10.1017/ipm.2023.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
Zooanthropy (delusional beliefs of turning into an animal) is a rare but well recognised psychiatric phenomenon. This case describes the presence of kynanthropic delusions (delusional beliefs of turning into a dog). Multiple other psychotic symptoms were also evident including unusually the additional presence of delusions of vampirism. Delusional beliefs in this case were associated with behavioural changes including growling and barking, and less commonly an expressed craving for biting people's necks to suck human blood. Symptom intensity was associated with increased psychosocial stressors for this patient, with some benefit noted from very high doses of anti-psychotic medications. Brief admissions to the acute psychiatric inpatient unit and thus removal from environmental stressors has been associated with an amelioration in symptomatology.
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Affiliation(s)
- K Mulholland
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
| | - A McLoughlin
- Department of Psychiatry, St. James's Hospital, Dublin 8, Ireland
| | - C McDonald
- Department of Psychiatry, National University of Ireland Galway, Galway, Ireland
| | - B Hallahan
- Galway-Roscommon Mental Health Services, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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8
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O'Brien M, Lynch D, Hallahan B, McNicholas F. Restoring Balance to the Recently Disputed Chemical Imbalance Theory of Depression. Ir Med J 2022; 115:668. [PMID: 36920325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Finnegan M, McLoughlin J, Bainbridge E, McGuinness D, Hallahan B, McDonald C. Quality of life after involuntary psychiatric admission. Int J Law Psychiatry 2022; 83:101810. [PMID: 35696760 DOI: 10.1016/j.ijlp.2022.101810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- M Finnegan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - J McLoughlin
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - E Bainbridge
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - D McGuinness
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - B Hallahan
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - C McDonald
- School of Medicine, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway, Ireland
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Frawley E, Cowman M, Cella M, Cohen D, Ryan E, Hallahan B, Bowie C, McDonald C, Fowler D, Wykes T, Donohoe G. Cognitive Remediation and Social Recovery in Early Psychosis (CReSt-R): protocol for a pilot randomised controlled study. Pilot Feasibility Stud 2022; 8:109. [PMID: 35610711 PMCID: PMC9126749 DOI: 10.1186/s40814-022-01064-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Psychosis, even in its early stages, is associated with significant disability, causing it to be ranked ahead of paraplegia and blindness in those aged 18-35 in terms of years lived with disability. Current pharmacological and psychological interventions intervention have focused primarily on the reduction of positive symptoms (hallucinations and delusions), with little benefit to domains of psychosis such as cognitive difficulties and social and occupational functioning. METHODS/DESIGN The CReSt-R intervention trial is a single center, pilot randomised controlled study based at the National University of Ireland (NUI), Galway. The trial will recruit participants from four clinical sites with assessment and intervention completed by the primary NUI Galway team. The trial will explore the feasibility, acceptability, and effectiveness of a novel psychosocial intervention for early psychosis based on a combined cognitive remediation training and cognitive behavioural therapy approach focused on social recovery. Participants, aged 16-35 within the first 5 years of a diagnosed psychotic disorder, will be recruited from the Children and Adolescent Mental Health Service and the Adult Mental Health Services in the region. DISCUSSION Cognitive remediation training (for improving cognition) and social recovery focused cognitive behavioural therapy, have both separately demonstrated effectiveness. This trial will evaluate the feasibility, acceptability, and explore the efficacy of a treatment approach that combines both approaches as part of an integrated, multicomponent intervention. TRIAL REGISTRATION Cognitive Remediation & Social Recovery in Early Psychosis (CReSt-R): ClincialTrials.gov Identifier NCT04273685. Trial registered Feb 18th, 2020. Last updated April 14th, 2021.
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Affiliation(s)
- E Frawley
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - M Cowman
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - M Cella
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, England
| | - D Cohen
- South Galway Child & Adolescent Mental Health Service, Health Service Executive, Merlin Park Hospital, Galway, Ireland
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - E Ryan
- Psychology Service, Adult Mental Health Service, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - C Bowie
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - C McDonald
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland
| | - D Fowler
- Department of Psychology, University of Sussex, Brighton, England
| | - T Wykes
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, England
| | - G Donohoe
- Centre for Neuroimaging, Cognition & Genomics (NICOG), School of Psychology, National University of Ireland, Galway, Ireland.
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11
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Murphy PT, Clogher L, van Laar A, O'Regan R, McManus S, McIntyre A, O'Connell A, Geraghty M, Henry G, Hallahan B. The impact of service user's suicide on mental health professionals. Ir J Psychol Med 2022; 39:74-84. [PMID: 30777583 DOI: 10.1017/ipm.2019.4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Our principle objective was to examine the personal and professional impact of service user (SU) suicide on mental health professionals (MHPs). We also wished to explore putative demographic or clinical factors relating to SUs or MPHs that could influence the impact of SU suicide for MHPs and explore factors MHPs report as helpful in reducing distress following SU suicide. METHODS A mixed-method questionnaire with quantitative and thematic analysis was utilised. RESULTS Quantitative data indicated SU suicide was associated with personal and professional distress with sadness (79.5%), shock (74.5%) and surprise (68.7%) particularly evident with these phenomena lasting less than a year for more than 90% of MHPs. MHPs also reported guilt, reduced self-confidence and a fear of negative publicity. Thematic analysis indicated that some MHPs had greater expertise when addressing SU suicidal ideation and in supporting colleagues after experiencing a SU suicide. Only 17.7% of MHPs were offered formal support following SU suicide. CONCLUSION SU suicide impacts MHPs personally and professionally in both a positive and negative fashion. A culture and clear pathway of formal support for MHPs to ascertain the most appropriate individualised support dependent on the distress they experience following SU suicide would be optimal.
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Affiliation(s)
- P T Murphy
- Galway Mental Health Service, HSE West, Health Centre, Brackernagh, Ballinasloe, Galway, Ireland
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - L Clogher
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - A van Laar
- Department of Liaison Psychiatry, University Hospital Galway, Galway, Ireland
| | - R O'Regan
- Child and Adolescent Mental Health Services, Inpatient Unit, Merlin Park Hospital Galway, Galway, Ireland
| | - S McManus
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - A McIntyre
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - A O'Connell
- Department of Psychology, HSE West, Merlin Park University Hospital, Galway, Ireland
| | - M Geraghty
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - G Henry
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - B Hallahan
- Department of Psychiatry, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
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12
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McMorrow C, Nerney D, Cullen N, Kielty J, vanLaar A, Davoren M, Conlon L, Brodie C, McDonald C, Hallahan B. Psychiatric and psycho-social characteristics of suicide completers: a 13-year comprehensive evaluation of psychiatric case records and post-mortem findings. Eur Psychiatry 2022; 65:e14. [PMID: 35067234 PMCID: PMC8853853 DOI: 10.1192/j.eurpsy.2021.2264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Currently, there are limited data comparing demographic and clinical characteristics of individuals who died by probable suicide and who did and did not previously attend mental health services (MHSs). This study compared demographic and clinical factors for both groups, in a Western region of Ireland over a 13-year period. Postmortem reports between January 1, 2006 and March 31, 2019 were reviewed for 400 individuals who died by probable suicide. Relevant sociodemographic and clinical data were extracted from individuals’ lifetime case notes. One hundred and fifty nine individuals (40%) had attended MHSs at some stage (“attendee”). Hanging was the most common method of suicide (61%), followed by drowning (18%) for both attendees and nonattendees of MHSs, with more violent methods utilized overall by nonattendees (p = 0.028). Sixty-eight percent of individuals who previously attempted hanging subsequently died utilizing this method. A higher proportion of attendees were female compared to nonattendees of MHSs (28.9 vs. 14.5%, p = 0.001). Recurrent depressive disorder (55%) was the most common diagnosed mental health disorder. For individuals with a diagnosis of schizophrenia, 39% had antipsychotic medications detectable in their toxicology reports. In conclusion, the majority of people who died by probable suicide had never had contact with MHSs, and nonattendees overall were more likely to utilize violent methods of suicide. Nonconcordance with psychotropic medications in psychotic patients and previous hanging attempt were highlighted as potential risk factors for death by probable suicide.
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Bainbridge E, Hallahan B, McGuinness D, Higgins A, Murphy K, Gunning P, Newell J, McDonald C. A Three-Month Follow-Up Study Evaluating Changes in Clinical Profile and Attitudes Towards Involuntary Admission. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2016.01.1746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IntroductionInvoluntary admission and treatment is often a traumatic experience for patients and there is a wide variation in attitudes towards care even when patients are recovered.Objectives/aimsThe purpose of this large prospective study was to identify clinical predictors of attitudes towards care during involuntary admission.MethodsThree hundred and ninety-one consecutively admitted involuntarily patients to three psychiatric inpatient units over a 30-month period were invited to participate in the study. Comprehensive assessments at admission and 3 months after discharge were attained including measures of symptoms, insight, functioning, attitudes towards involuntary admission and coercive experiences. Multiple linear regression modelling was used to determine the optimal explanatory variables for attitudes towards care.ResultsTwo hundred and sixty-three individuals participated at baseline and 156 (59%) successfully completed follow-up assessments. Individuals improved significantly over time clinically and in their attitudes towards their care. At baseline greater insight (P < 0.001) and less symptoms (P = 0.02) were associated with more positive attitudes towards care as was older age (P = 0.001). At follow-up, greater insight (P < 0.001), less symptoms (P = 0.02) and being older (P = 0.04) were associated with more positive attitudes towards care. More positive attitudes towards care at follow-up were associated with greater improvements in insight over time (P < 0.001) and having a diagnosis of an affective psychosis (P = 0.0009).ConclusionsThe best predictors of positive attitudes towards care during and after involuntary admission are illness related factors, such as levels of insight and improvement in insight, rather than service or legislation related factors, such as the use of coercive measures, seclusion and restraint.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hargreaves A, Dillon R, Castorina M, Furey E, Walsh J, Fitzmaurice B, Hallahan B, Corvin A, Robertson I, Donohoe G. Predictors of adherence to low support, computerised, cognitive remediation training in psychosis. Psychosis 2018. [DOI: 10.1080/17522439.2018.1522542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A. Hargreaves
- Department of Psychology, National College of Ireland, Dublin, Ireland
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - R. Dillon
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - M. Castorina
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - E. Furey
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| | - J. Walsh
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
| | - B. Fitzmaurice
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - B. Hallahan
- Department of Psychiatry, & Center for Neuroimaging and Cognitive Genomics, National University of Ireland, Galway, Ireland
| | - A. Corvin
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
| | - I. Robertson
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - G. Donohoe
- Department of Psychiatry, Trinity College Dublin, Dublin, Ireland
- School of Psychology & Center for Neuroimaging and Cognitive Genomics, National University of Ireland Galway, Galway, Ireland
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Murphy V, Hallahan B, Smithwick D, Costello S, Moloney N, Gulati G. Epilepsy in Irish psychiatric inpatient settings. Ir Med J 2018; 111:809. [PMID: 30547542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aims To ascertain epilepsy prevalence in Irish psychiatric inpatient units and compliance with care planning guidelines. Methods Case records were reviewed in seven psychiatric inpatient units. Results The prevalence of epilepsy across seven psychiatric inpatient units (n=9/267) was three times that of general population estimates. Minimal data was recorded pertaining to seizure type (n=1,11.1%), triggers (n=2,22.2%), clinical investigations relating to epilepsy (n=2,22%) and no epilepsy risk assessments were recorded (n=0,0%). Conclusions The introduction of appropriate care plans is needed to optimise physical and mental wellbeing of those with epilepsy in psychiatric units.
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Affiliation(s)
- V Murphy
- Department of Psychiatry, University College Cork, Cork, Ireland
| | - B Hallahan
- Department of Psychiatry, NUI Galway, Galway, Ireland
| | - D Smithwick
- Department of Psychiatry, Ennis General Hospital, Ireland
| | - S Costello
- Department of Psychiatry, University Hospital Galway, Ireland
| | - N Moloney
- Department of Psychiatry, University of Limerick, Ireland
| | - G Gulati
- Department of Psychiatry, University of Limerick, Ireland
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Donohoe G, Dillon R, Hargreaves A, Mothersill O, Castorina M, Furey E, Fagan AJ, Meaney JF, Fitzmaurice B, Hallahan B, McDonald C, Wykes T, Corvin A, Robertson IH. Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial. Psychol Med 2018; 48:751-764. [PMID: 28933314 DOI: 10.1017/s0033291717001982] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis. METHODS Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment. RESULTS Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition. CONCLUSIONS CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.
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Affiliation(s)
- G Donohoe
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - R Dillon
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - A Hargreaves
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - O Mothersill
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - M Castorina
- Trinity College Institute of Neuroscience,Trinity College Dublin,Ireland,Trinity College Dublin,Ireland
| | - E Furey
- School of Psychology& Center for Neuroimaging and Cognitive Genomics,National University of Ireland Galway,Galway,Ireland
| | - A J Fagan
- National Centre for Advanced Medical Imaging (CAMI),St. James's Hospital/School of Medicine,Trinity College Dublin,Dublin,Ireland
| | - J F Meaney
- National Centre for Advanced Medical Imaging (CAMI),St. James's Hospital/School of Medicine,Trinity College Dublin,Dublin,Ireland
| | - B Fitzmaurice
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - B Hallahan
- Department of Psychiatry & Center for neuroimaging and Cognitive genomics,National University of Ireland Galway,Ireland
| | - C McDonald
- Department of Psychiatry & Center for neuroimaging and Cognitive genomics,National University of Ireland Galway,Ireland
| | - T Wykes
- Institute of Psychiatry,Psychology & Neuroscience,King's College London,London,England
| | - A Corvin
- Department of Psychiatry,Trinity College Dublin,Dublin,Ireland
| | - I H Robertson
- Trinity College Institute of Neuroscience,Trinity College Dublin,Ireland,Trinity College Dublin,Ireland
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McGuinness D, Higgins A, Hallahan B, Bainbridge E, McDonald C, Murphy K. Preserving Control: Understanding People's Experiences Before, During and After Detention Under the Irish Mental Health Act 2001. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
IntroductionThe Mental Health Act 2001 provides a legal framework for the involuntary admission and treatment of individuals deemed to have a mental disorder to psychiatric units. The perspectives of people who have been detained are relatively poorly understood.ObjectiveTo develop a theoretical understanding of individual's experiences throughout the trajectory of their detention and to understand the psychological and social processes that individuals use to cope before, during and after detention.MethodsFifty individuals subject to detention across three psychiatric units consented to be interviewed three months after their detention. Using a semi-structured interview people recounted their experiences. Interviews were analysed using the principles underpinning Grounded Theory.ResultsThe theory ‘Preserving Control’ encapsulates individuals’ experiences and consists of three related themes: ‘Losing Control’, ‘Regaining Control’ and ‘Maintaining Control’. ‘Losing Control’ describes individuals’ experiences of losing their autonomy and liberty thought the process of detention and hospitalisation. ‘Regaining Control describes, the strategies individuals used in an attempted to restore their loss of autonomy and control. ‘Maintaining Control’ describes how individuals lived with the consequences of detention and contended with impact on discharge.ConclusionsWhilst a large variation existed in relation to the subjective experience of being detained, the characteristic process that individuals tend to experience related to identifiable phases of preserving control in the face of this loss of autonomy. Findings from this study highlight the importance of more sensitive interactions support and information during and after the detention process.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Murphy RA, Hallahan B. Psychosis improved dysphonia. Case Reports 2013; 2013:bcr-2013-201531. [DOI: 10.1136/bcr-2013-201531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Murphy CM, Deeley Q, Daly E, Ecker C, O'Brien F, Hallahan B, Loth E, Toal F, Reed S, Hales S, Robertson D, Craig M, Mullins D, Barker G, Lavender T, Johnston P, Murphy K, Murphy D. Anatomy and aging of the amygdala and hippocampus in autism spectrum disorder: an in vivo magnetic resonance imaging study of Asperger syndrome. Autism Res 2011; 5:3-12. [DOI: 10.1002/aur.227] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 07/20/2011] [Indexed: 11/08/2022]
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Toal F, Daly EM, Page L, Deeley Q, Hallahan B, Bloemen O, Cutter WJ, Brammer MJ, Curran S, Robertson D, Murphy C, Murphy KC, Murphy DGM. Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study. Psychol Med 2010; 40:1171-1181. [PMID: 19891805 DOI: 10.1017/s0033291709991541] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Autistic spectrum disorder (ASD) is characterized by stereotyped/obsessional behaviours and social and communicative deficits. However, there is significant variability in the clinical phenotype; for example, people with autism exhibit language delay whereas those with Asperger syndrome do not. It remains unclear whether localized differences in brain anatomy are associated with variation in the clinical phenotype. METHOD We used voxel-based morphometry (VBM) to investigate brain anatomy in adults with ASD. We included 65 adults diagnosed with ASD (39 with Asperger syndrome and 26 with autism) and 33 controls who did not differ significantly in age or gender. RESULTS VBM revealed that subjects with ASD had a significant reduction in grey-matter volume of medial temporal, fusiform and cerebellar regions, and in white matter of the brainstem and cerebellar regions. Furthermore, within the subjects with ASD, brain anatomy varied with clinical phenotype. Those with autism demonstrated an increase in grey matter in frontal and temporal lobe regions that was not present in those with Asperger syndrome. CONCLUSIONS Adults with ASD have significant differences from controls in the anatomy of brain regions implicated in behaviours characterizing the disorder, and this differs according to clinical subtype.
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Affiliation(s)
- F Toal
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
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Hallahan B, Daly EM, McAlonan G, Loth E, Toal F, O'Brien F, Robertson D, Hales S, Murphy C, Murphy KC, Murphy DGM. Brain morphometry volume in autistic spectrum disorder: a magnetic resonance imaging study of adults. Psychol Med 2009; 39:337-346. [PMID: 18775096 DOI: 10.1017/s0033291708003383] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several prior reports have found that some young children with autism spectrum disorder [ASD; including autism and Asperger's syndrome and pervasive developmental disorder - not otherwise specified (PDD-NOS)] have a significant increase in head size and brain weight. However, the findings from older children and adults with ASD are inconsistent. This may reflect the relatively small sample sizes that were studied, clinical heterogeneity, or age-related brain differences. METHOD Hence, we measured head size (intracranial volume), and the bulk volume of ventricular and peripheral cerebrospinal fluid (CSF), lobar brain, and cerebellum in 114 people with ASD and 60 controls aged between 18 and 58 years. The ASD sample included 80 people with Asperger's syndrome, 28 with autism and six with PDD-NOS. RESULTS There was no significant between-group difference in head and/or lobar brain matter volume. However, compared with controls, each ASD subgroup had a significantly smaller cerebellar volume, and a significantly larger volume of peripheral CSF. CONCLUSIONS Within ASD adults, the bulk volume of cerebellum is reduced irrespective of diagnostic subcategory. Also the significant increase in peripheral CSF may reflect differences in cortical maturation and/or ageing.
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Affiliation(s)
- B Hallahan
- Section of Brain Maturation, Department of Psychological Medicine, Institute of Psychiatry, King's College, London, UK.
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Abstract
Hemolymph was examined in young (ca. 86 days old), mature (ca. 163 days old), and old (ca. 294 days old) Aplysia for age-related changes in constituent proteins. In young, mature, and old animals protein concentrations were 1.6 +/- 0.27, 1.41 +/- 0.53, and 1.45 +/- 0.43 mg.ml-1, respectively. The copper-containing respiratory protein, hemocyanin, measured by determining the copper concentration, was found to increase significantly from young (0.98 +/- 0.51 microgram.ml-1) to mature (2.02 +/- 0.95 micrograms.ml-1) Aplysia, with little change between mature and old (1.92 +/- 0.43 micrograms.ml-1) animals. These findings were consistent with the results obtained when hemocyanin was directly measured by spectrophotometric absorption at 340 nm. Acetylcholinesterase (AChE) was present in the hemolymph of Aplysia. Its activity was highest in mature animals (3121 +/- 1627 units.mg-1) and least in old animals (1463 +/- 599 units.mg-1). Young animals had intermediate levels (2080 +/- 762 units.mg-1). SDS-PAGE revealed a distinct pattern of protein bands for hemolymph from each age group; hemolymph from the young group contained six prominent protein bands with molecular weights (MW) from 13 to 300 kDa. Hemolymph of mature and old animals exhibited four and three prominent protein bands, respectively, with MW between 45 and 300 kDa. A prominent band at 97 kDa was present in samples from the mature group, but was faint in samples from the old group and absent in samples from the young group.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Srivatsan
- Department of Physiology and Biophysics, University of Kentucky Medical Center, Lexington 40536-0084
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