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Introduction: Substance use disorders (SUDs) and addictive behaviours are growing problems which negatively impact health and wellbeing. Occupational therapy can support recovery by facilitating engagement in everyday activities that promote health. To date, the inclusion of occupational therapy in addiction recovery is limited and the evidence base for occupation-focused interventions is lacking. This study explores the impact of an occupational therapy-led intervention on self-reported occupational performance and occupational balance issues for people living with SUDs within an inpatient addiction service. Methodology: A quantitative pre and post-test study was implemented. The Canadian Personal Recovery Outcome Measure (C-PROM) was the sole outcome measure. The C-PROM is a self-report measure which aims to measure personal views of recovery based on rating activity engagement. The cohort of participants were recruited from referrals into 2 inpatient addiction recovery treatment programmes using purposive sampling. Descriptive statistics were run, and a Wilcoxon Signed Rank Test was used to analyse pre and post-test scoring. Results: Sixteen participants (9 male and 7 female) completed the intervention and outcome measure. The majority of participants (31.3%, n = 5) were between 45 and 54 years old. 25% of the sample (n = 4) were in the 35 to 44 age bracket while 18.8% (n = 3) were aged 55 to 64. The majority of participants (68.8%, n = 11) reported substance misuse as their main healthcare concern. The mean score on the C-PROM was significantly higher after participants received the intervention when compared with baseline scoring. Conclusion: Following engagement with an occupational therapist-led intervention participants reported increased engagement in activities and occupational performance. Participants also reported improved occupational balance and increased awareness of personal recovery needs. Further research is required to explore the effectiveness of this intervention in larger samples and to explore the transferability and sustainability of skills post discharge.

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OBJECTIVES: The aim of this study was to examine symptom profiles of people diagnosed with attention-deficit/hyperactivity disorder (ADHD) and/or anxiety (ANX) in order to determine the validity of widely used ADHD and ANX rating scales for differential diagnostic use and to develop modified measures that take symptom overlap into account. DESIGN: A cross-sectional design was used to assess differences in rating scale scores between clinical (n = 52) and control (n = 74) samples as well as differences among subgroups of the clinical sample (22 ADHD; 16 ADHD + ANX; 14 ANX). METHOD: Participants completed an online questionnaire where they responded to the Conners Adult ADHD Rating Scale (CAARS; Conners, Erhardt, & Sparrow, ) and State Trait Anxiety Inventory scales (STAI; Spielberger, Gorsuch, Lushene, Vagg, & Jacobs, ). RESULTS: Results showed that the CAARS and STAI had limited sensitivity and specificity and may lack in ability to differentially diagnose ADHD and/or ANX. Cluster analysis was used to guide the proposal of modifications for the two scales, which were to use inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for use in differential diagnosis. Further parametric analysis supported these proposed modifications. CONCLUSIONS: Clinicians should be made aware of the limitations of the CAARS and STAI scales in terms of specificity, when used to inform differential diagnosis of ADHD and ANX. Further analysis on the psychometric properties of these modified scales is needed in order to confirm that they are valid and reliable scales. PRACTITIONER POINTS: Clinical implications It is possible that widely used self-report rating scales are not valid for use in the context of assessing adult ADHD when ANX is present. Clinicians should take alternative approaches to measuring ADHD symptoms in the context of ANX. Findings of the present study suggest the use of inattentive items only for the CAARS and to exclude state ANX-present items on the STAI for differential diagnostic use. Limitations of the study The sample sizes of the clinical subgroups were relatively small. Diagnoses were not confirmed using a semi-structured clinical interview. Alternative cluster approaches (e.g., two-step clustering using larger samples) would provide further insight.

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Since the 1960s, both corticotropin-releasing hormone (CRH) and the hypothalamic-pituitary-adrenal (HPA) axis have been studied in detail across a range of psychiatric illnesses, leading to important contributions to our knowledge in this area. This research arose from the conceptualization of depression, in particular, as a stress-related disorder. However, stress is now regarded as an integral component of psychiatric illnesses in general, whether as an environmental trigger or in the initial pathogenesis, and there is evidence of altered HPA axis function across a range of mental disorders. The chapter will cover the extensive literature on HPA axis abnormalities in these disorders with a particular emphasis on the CRH system as it is very evident that this 41-amino acid-containing peptide is not only a major physiologic regulator of HPA axis activity but also important in the pathogenesis of mental disorders. In particular, we discuss the abundant reports pertaining to major depressive disorder, where hyperactivity of the HPA axis, of mild to moderate severity, has been demonstrated in 30-50% of cases. Also under consideration is the less extensively studied, but equally intriguing question of HPA axis integrity in bipolar affective disorder. In addition there will be a concise summary of recent findings in schizophrenia and anxiety disorders, with an emphasis on post-traumatic stress disorder (PTSD) in the latter case. Interestingly, in diametric opposition to the theory of HPA hyperactivity in depression, PTSD has features consistent with hypofunctioning of this system. Advances in animal and human studies have made it possible to synthesize these findings, and while much still remains unknown, we are gradually building up a clearer picture of this very important axis in health, at times of stress, and in chronic enduring mental illness.

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INTRODUCTION: Recent research has seen low-dose ketamine emerge as a novel, rapid-acting antidepressant. Ketamine, an N-methy-d-aspartate (NMDA) receptor antagonist, leads to effects on the glutamatergic system and abnormalities in this neurotransmittor system are present in depression. This article aims to (1) review the clinical literature on low-dose ketamine as a rapid-acting antidepressant in affective disorders, (2) provide a critical overview of the limitations of ketamine and research attempts to overcome these (3) discuss the proposed mechanisms of action of ketamine and (4) point towards future research directions. METHOD: The electronic database Pubmed, Web of Science and sciencedirect were searched using the keywords: ketamine, N-methyl-d-aspartate receptor antagonist, rapid-acting antidepressant, depression, treatment-resistant depression, bipolar depression, suicidal ideation, electroconvulsive therapy, mechanism of action. RESULT: The literature demonstrates evidence supporting a rapid-acting antidepressant effect of low-dose intravenous ketamine in major depressive disorder, in bipolar depression and in depression with suicidal ideation. There are mixed results as to whether ketamine leads to a reduction in time to remission in patients undergoing electroconvulsive therapy (ECT). Efforts to unravel ketamine's therapeutic mechanism of action have implicated the mammalian target of rapamycin (mTOR)-dependent synapse formation in the rat prefrontal cortex, eukaryotic elongation factor 2 phosphorylation (p-eEF2) and glycogen synthase kinase (GSK-3). Ketamine's limiting factors are the transient nature of its antidepressant effect and concerns regarding abuse, and research efforts to overcome these are reviewed. CONCLUSION: Current and future research studies are using ketamine as a promising tool to evaluate the glutamatergic neurotransmittor system to learn more about the pathophysiology of depression and develop more specific rapid-acting antidepressant treatments.

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BACKGROUND: Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group. METHODS: Of 93 patients detained in a forensic mental health hospital under both forensic and civil mental health legislation, 19 were assessed as suitable for MCT and 11 commenced. These were compared with 8 waiting list patients also deemed suitable for group MCT who did not receive it in the study timeframe. The PANSS, GAF, MacArthur Competence Assessment Tool- Treatment (MacCAT-T) and MacArthur Competence Assessment Tool-Fitness to Plead (MacCAT-FP) were recorded at baseline and repeated after group MCT or following treatment as usual in the waiting list group. RESULTS: When baseline functioning was accounted for, patients that attended MCT improved in capacity to consent to treatment as assessed by the MacCAT-T (p = 0.019). The more sessions attended, the greater the improvements in capacity to consent to treatment, mainly due to improvement in MacCAT-T understanding (p = 0.014) and reasoning . The GAF score improved in patients who attended the MCT group when compared to the waiting list group (p = 0.038) but there were no changes in PANSS scores. CONCLUSION: Measures of functional mental capacity and global function can be used as outcome measures for MCT. MCT can be used successfully even in psychotic patients detained in a forensic setting. The restoration of elements of decision making capacity such as understanding and reasoning may be a hither-to unrecognised advantage of such treatment. Because pharmacotherapy can be optimised and there is likely to be enough time to complete the course, there are clear opportunities to benefit from such treatment programmes in forensic settings.

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PURPOSE: A large Dublin-based teaching hospital facilitates a weekly Psychiatric Case Presentation meeting, which is relatively unique in medicine and even in psychiatry, in that there is a large variety of attendees from various multidisciplinary groups: consultant psychiatrists, psychiatric trainees, nurses, psychologists and psychoanalytic psychotherapists, occupational therapists, social workers and pastoral care staff. The aim of this audit is to assess the quality of education for members of different disciplines at these meetings, and to highlight the differing learning needs of the attendees. DESIGN/METHODOLOGY/APPROACH: Group-structured assessments and Likert scale questionnaires were used to identify what attendees thought were educational and what needed to be improved. FINDINGS: Overall, the case conference is educationally worthwhile but there were several areas of dissatisfaction. Some felt that the case conference was overly medical in its orientation and that there was excessive medical jargon. The seating arrangements were not conducive to group discussion. Consultants and psychiatric trainees felt that the quality of the clinical presentations could be improved. Presentation skills teaching classes and topic-based classes would be useful inclusions. Feedback to the multidisciplinary group on the patients' progress and feedback to the patient is important. Changes were implemented in areas of dissatisfaction, and these changes evaluated. ORIGINALITY/VALUE: The educational qualities of multidisciplinary Case Conferences need to be constantly evaluated to ensure that the learning needs of the different disciplines who attend are being met.

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We describe an unusual cause of autobiographical memory loss in a 55 year old man who presented with prominent memory loss for significant events in his life over a period of five years with evidence of patchy memory loss for events prior to this. It was associated with emotional lability and was complicated by a number of tragic events in his life in the previous four years. In addition there were a number of brief episodes (< 30 mins) where he would transiently lose his memory for events including for hours, days or months prior to the event. Neuropsychological assessment confirmed prominent autobiographical memory loss with minimal deficits in other domains. An electroencephalogram (EEG) revealed a simple partial seizure arising from the right temporal lobe, pointing to a diagnosis of Transient Epileptic Amnesia. He was commenced on anti-epileptic medication and responded both subjectively and objectively. There are approximately 94 cases of TEA described in the literature and the diagnostic criteria and postulated aetiology of this illness is discussed here. Clinicians need to have high index of suspicion of epilepsy when assessing a patient with prominent autobiographical memory impairments.

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Serotonin (5-hydroxytryptamine, 5-HT) mediates a wide variety of physiological functions by activating multiple receptors, and abnormalities of these receptor systems has been implicated in many psychiatric disorders including anxiety, depression, psychosis, migraine, disorders of sexual functioning, sleep, cognition, and feeding. Many of the currently used treatments for these disorders act by affecting the serotonergic system. Observation of serotonin receptor alterations, before and following effective treatments, may yield important insights into the aetiology of these psychiatric disorders and may ultimately lead to more selective and effective therapies. Copyright 2000 John Wiley & Sons, Ltd.