ObjectiveThe study was designed to establish and evaluate the impact of a 6-week Balint group on empathy and resilience in fourth-year medical students during their psychiatry rotation.MethodologyThis prospective study used the Jefferson Scale of Empathy – Student Version and the Brief Resilience Scale before and after 6-week Balint groups. Participating students also completed a qualitative assessment of their experience.ResultsStudents who participated were enthusiastic regarding the value of Balint groups in promoting self-reflection and gaining insight into self- and patient-care dynamics. There was a significant difference in empathy scores pre- and post-Balint intervention. There was no significant difference in resilience scores.ConclusionThe establishment of a 6-week Balint group for fourth-year medical students was successful in increasing empathy. Students reported a positive view of Balint and its beneficial role in this study group.

Objectives: To examine the impact of the first full year of the COVID-19 pandemic and its associated restrictions on the volume and nature of psychiatric presentations to an emergency department (ED) in a large academic hospital. Methods: Anonymised clinical data on psychiatric presentations to the ED were collected for the 52-week period from the start of the COVID-19 pandemic and compared with corresponding 1 year periods in 2019 and 2018. Results: There was a significant increase in psychiatric presentations overall to the ED during the first year of the COVID-19 pandemic compared to previous years, in contrast to a reduction in total presentations for all other specialties. There was a marked increase in psychiatric presentations of those below 18 years, and in the 30–39 years and 40–49 years age groups, but a decrease in the 18–29 years group. There was a significant increase in anxiety disorder presentations but a decrease in alcohol related presentations. There was no significant change observed in the rates of presentations for self-harm or suicidal ideation. Conclusions: Psychiatric presentations to the ED have increased during the first year of the COVID-19 pandemic in contrast to a decrease in presentations for other medical specialties, with this increase being driven by out-of-hours presentations. The fourfold increase in presentations of young people below the age of 18 years to the ED with mental health difficulties is an important finding and suggests a disproportionate burden of psychological strain placed on this group during the pandemic.

BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors (representing 20% of all Irish registered doctors), which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were obtained, the majority of which were from young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe (χ2=17.51, p<0.001). Interns being less likely to self-prescribe was not unexpected (χ2=69.55, p<0.001), while general practitioners (GPs) and paediatricians were more likely to self-prescribe (χ2=13.33, p<0.001; χ2=11.35, p<0.001). GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family (χ2=5.19, p<0.05; χ2=8.38, p<0.05; χ2=6.17, p<0.05) and surgeons were more likely to prescribe to friends (χ2=15.87, p<0.001). Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids (χ2=7.82, p<0.01; χ2=7.31, p<0.01; χ2=4.91, p<0.05), while those in hospital medicine were more likely to self-prescribe psychotropic medications (χ2=5.47, p<0.05).ConclusionPrescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it.

Objective: Few studies have described the treatment or outcome of depression in specialized mood disorders units (MDUs). Previous studies have focused on cohorts of patients with highly treatment-resistant illness who are likely to have a poor prognosis even with intensive treatment. This study describes the treatment and medium-term outcomes of a cohort of first-admission depressed patients with less treatment-resistant illness treated in a specialized MDU. Methods: A cohort of 137 consecutive first-admission depressed patients, referred to an MDU over 2 years, were interviewed using standardized schedules and followed up prospectively from admission for ∼18 months to describe baseline characteristics, treatment, outcome, and predictors of outcome. Times to recovery and recurrence were evaluated using survival analyses and predictors of outcome were examined using bivariate and multivariate regression analyses. Results: On admission, 75% of the 137 patients had depression that had been found to be resistant to pharmacological treatment, and 34% had been chronically depressed (>2 y). Over half of the patients had likely maladaptive personality traits and one third had at least 1 comorbid psychiatric disorder. By discharge, a significantly higher proportion of the patients were being prescribed very high (P<0.01) or high doses (P<0.05) of antidepressants, augmentation therapy (P<0.001), or a combination of antidepressants (P<0.001) or were engaged in individual psychotherapy (P<0.001), compared with baseline. With intensive treatment, 62% of the patients recovered by 6 months and 76% by 12 months, with 83% overall recovering and patients found to be asymptomatic during almost 60% of the follow-up period. However, 48% suffered a recurrence over the course of the follow-up. Chronicity of mood episodes (P<0.01) and the presence of psychiatric comorbidity (P<0.05) predicted recurrence. Conclusions: This prospective, naturalistic, medium-term study describes better outcomes, in terms of recovery and symptomatology over time, in a cohort of first-admission depressed patients than previous first-admission studies after continuous, intensive treatment, although the proportion of patients who experienced recurrences remained high.