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Biomedical subjects

T J Fahy

Publications and source records attributed to T J Fahy.

At least 19 recordsLinked to original sources
PubMed2002

Risperidone in chronic schizophrenia: a detailed audit, open switch study and two-year follow-up of patients on depot medication.

Little information exists on the medium- to long-term outcome of switching patients with schizophrenia from traditional depot to atypical oral antipsychotic agents. By detailed clinical audit, we identified a representative group of 102 patients of an Irish psychiatric service with DSM-IV chronic schizophrenia and on depot neuroleptics for a mean of 15 years. Of 69 eligible to participate, 33 entered a 6-month switch study of risperidone, with limited follow-up of consenters and non-consenters at 1 and 2 years. At 6 months, 23 of 33 were still on risperidone and had small significant improvements in clinical and extrapyramidal side effects, QOL and adjunct medication measures over baseline. At 12 months, 19 of 33 were still on risperidone, reducing to 13 of 33 at 2 years. At 2 years, of 32 surviving consenters to switch, 19 had suffered clinically detrimental events and were no longer on risperidone, compared to none of the 33 surviving non-consenters, who were all still on depot. These findings suggest that switching from depot to risperidone may encounter high rates of refusal and attrition subsequent to switch. While a majority of switched patients may improve to least 6 months, audit plus switch may have clinically unfavourable effects on others over a 2-year follow-up period [corrected].

Adolescent↗
PubMed1999

PTSD in ambulant RTA victims: a randomized controlled trial of debriefing.

This report examines initial distress levels, course of symptoms, incidence of posttraumatic stress disorder (PTSD), predictors of short-term outcome, and value of prophylactic counseling in a consecutive series of 40 ambulant trauma clinic attenders with minor road traffic accident (RTA) injuries. Subjects were randomly allocated to intervention and monitoring groups following assessment at a mean of 7 days posttrauma and reassessed at 3 months using a variety of standard rating scales. Seventy-five percent reported significant levels of distress at 1 week posttrauma. By 3 months this had decreased sharply to 35%, and 22% were significantly impaired by clinical assessment. Incidence of PTSD over 3 months was estimated at 19% and point prevalence at 3 months posttrauma was 9%. High initial distress, increasing age, and high levels of perceived threat were significant independent predictors of morbidity, and no significant differences in outcome were found between intervention and monitoring groups at 3 months.

Accidents, Traffic↗
PubMed1998

Telepsychiatry: an island pilot project.

A telemedicine link was established in 1996 between the island of Inishmore and the department of psychiatry in University College Hospital, Galway. The link was mainly used to facilitate emergency consultations between patients on the island and the duty psychiatrist, always at the request of the island's general practitioner. Nine patients were referred for assessment in this manner over eight months. Three patients had their first psychiatric contact and assessment through the video-link, and were followed up as outpatients via the link to eventual resolution of the episode of illness and discharge at the outpatient clinic. Our experience has been that videoconferencing systems are acceptable and satisfactory for patients and staff alike.

Adult↗
PubMed1996

The Galway Study of Panic Disorder. III. Outcome at 5 to 6 years.

BACKGROUND: The aim was to evaluate long-term outcome of DSM-III-R panic disorder at a mean of 5.3 years following a controlled trial of treatment that included antidepressants and behavioural counselling. METHOD: Sixty-eight (86%) subjects were evaluated by lengthy research interview. RESULTS: Thirty-four per cent recovered and remained well, 46% were minimally impaired and 20% had persistent panic disorder of whom half remained significantly impaired. Anxious-fearful personality dysfunction was the most important predictor of poor outcome, followed by poor clinical status at discharge and inability at baseline to recall vividly the initial panic attack. Those who dropped out from the original trial did badly. CONCLUSIONS: Complete recovery can occur even after many years of severe illness in a large minority of subjects who receive both antidepressants and behavioural counselling in the acute stage of treatment. The comparative prognostic value of personality, severity and chronicity need to be more fully addressed in future studies.

Adult↗
PubMed1996

The Galway Study of Panic Disorder. IV. Temporal stability of diagnosis by present state examination test-retest.

BACKGROUND: A long-term outcome study of DSM-III-R panic disorder included the Present State Examination (PSE) at baseline and follow up five to six years later. METHOD: PSE test-retest and individual within-patient change scores on various PSE syndromes were assessed for consistency with either a categorical view of panic disorder as a stable clinical entity or panic disorder as one facet only of a "general neurotic syndrome'. RESULTS: PSE profile at baseline was virtually identical with that at follow up. Few patients had changed in PSE syndrome diagnosis after five to six years. CONCLUSION: These data, although not conclusive, are supportive of the concept of DSM-III-R panic disorder as a stable clinical entity and are correspondingly difficult to reconcile with the view that panic disorder is but one facet only of a general neurotic syndrome.

Antidepressive Agents, Tricyclic↗
PubMed1992

The Galway Study of Panic Disorder. I: Clomipramine and lofepramine in DSM III-R panic disorder: a placebo controlled trial.

Among 79 volunteer, unpaid, family doctor-referred psychiatric out patients with DSM III-R panic disorder, with and without agoraphobia, 66 completed a six week placebo-controlled trial of lofepramine versus clomipramine and 57 survivors were followed up for 6 months. All subjects received one hour per week concurrent behavioural counselling in the acute phase. Of 13 dropouts in the first 3 weeks, 9 (of 27) were on clomipramine, 2 (of 26) were on lofepramine and 2 (of 26) were on placebo. The high (30%) early dropout from the clomipramine group was largely due to medication intolerance. Both drugs were superior to placebo by the end of week 6 on several standard rating scales but not on panic attack frequency. No significant differences in efficacy were found between the two drugs tested to the end of 6 months. No tendency for relapse was noted in the three months following taper-off of medication from week 12 to week 24. The study provides evidence that both drugs, in the dosages used, are superior to placebo in the acute phase of panic disorder in treatment-naive subjects concurrently receiving appropriate psychotherapy.

Adult↗
PubMed1988

Some influences on regional variation in frequency of prescription of electroconvulsive therapy.

A Republic of Ireland national survey of electroconvulsive therapy (ECT) showed wide inter-hospital variation in ECT rates. Psychiatric admission rates, professional attitudes, and patient turnover were found to predict these rates. No significant association was found between ECT rates and public/private care or other socio-economic factors. A limited examination of British admission data revealed a similar set of correlations, suggesting that the findings may apply in non-profit health-care systems outside the Republic of Ireland.

Aged↗
PubMed1983

Suicide rates in Ireland.

From a total of 410 post-mortem examinations on Galway residents deceased in 1978 the examining pathologist and 3 psychiatrists were in close agreement in 22 cases that death was by suicide. These figures were extrapolated, and a Republic of Ireland minimum true rate of suicide was computed which was 3 times greater than the official reported rate. Irish suicide data were found not to be dependent on coroners' reports as is commonly believed. It is concluded that under-reporting reduces Irish suicide rates to a far greater extent than has been supposed. The substitution of clinical for legalistic methods of recording suicide data is recommended.

Adolescent↗
PubMed1982

Who receives the aftercare? Utilization of services by discharged in-patients.

A prospective one-year follow-up of 216 in-patients showed that utilization of aftercare was significantly associated with certain clinical and social factors in the year after discharge from hospital. Rural domicile, a diagnosis of schizophrenia, long dependence on services, and ease of access to care comprised an aftercare dependency syndrome with substantial predictive power. Alcoholic and personality disordered patients were light users of services. Staff-patient relationships and attitudes of staff and patients to the need for aftercare were important. Depot neuroleptics were associated with high levels of aftercare for patients with chronic schizophrenia. The findings reveal the steady silting up of a new area service for the adult mentally ill by patients with a combination of social disadvantage and severe chronic psychosis. Family doctors played very little part in the delivery of aftercare. Some implications of the findings for the future development of community-based psychiatric services are discussed.

Adolescent↗