Biomedical subjects

K Kiernan

Publications and source records attributed to K Kiernan.

11 recordsLinked to original sources

PubMed2000

Effect of death of Diana, princess of Wales on suicide and deliberate self-harm.

BACKGROUND: The death of the Princess of Wales in 1997 was followed by widespread public mourning. Such major events may influence suicidal behaviour. AIMS: To assess the impact of the Princess's death on suicide and deliberate self-harm (DSH). METHOD: Analysis, using Poisson regression, of the number of suicides and open verdicts ('suicides') in England and Wales following the Princess's death compared to the 3 months beforehand, and the equivalent periods in 1992-1996. Similar analysis on DSH presentations to a general hospital. RESULTS: Suicides increased during the month following the Princess's funeral (+17.4%). This was particularly marked in females (+33.7%), especially those aged 25-44 years (+45.1%). Suicides did not fall in the week between the death and the funeral. Presentations for DSH increased significantly during the week following the death (+44.3%), especially in females (+65.1%). Examination of case notes suggested that the influence of the death was largely through amplification of personal losses or exacerbation of existing distress. CONCLUSIONS: The death of a major public figure can influence rates of suicidal behaviour. For DSH, the impact may be immediate, but for suicide it may be delayed.

Adolescent↗

PubMed1999

Suicide within 12 months of contact with mental health services: national clinical survey.

OBJECTIVE: To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk.

Adolescent↗

PubMed1999

Mental disorder and clinical care in people convicted of homicide: national clinical survey.

OBJECTIVES: To estimate the rate of mental disorder in those convicted of homicide and to examine the social and clinical characteristics of those with a history of contact with psychiatric services. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: Eighteen month sample of people convicted of homicide. MAIN OUTCOME MEASURES: Offence related and clinical information collected from psychiatric court reports on people convicted of homicide. Detailed clinical data collected on those with a history of contact with psychiatric services. RESULTS: 718 homicides were reported to the inquiry between April 1996 and November 1997. Of the 500 cases for whom psychiatric reports were retrieved, 220 (44%; 95% confidence interval 40% to 48%) had a lifetime history of mental disorder, while 71 (14%; 11% to 17%) had symptoms of mental illness at the time of the homicide. Of the total sample, 102 (14%; 12% to 17%) were confirmed to have been in contact with mental health services at some time, 58 (8%; 6% to 10%) in the year before the homicide. The commonest diagnosis was personality disorder (20 cases, 22%; 13% to 30%). Alcohol and drug misuse were also common. Only 15 subjects (18%; 10% to 26%) were receiving intensive community care, and 60 (63%; 53% to 73%) were out of contact at the time of the homicide. CONCLUSIONS: There are substantial rates of mental disorder in people convicted of homicide. Most do not have severe mental illness or a history of contact with mental health services. Inquiry findings suggest that preventing loss of contact with services and improving the clinical management of patients with both mental illness and substance misuse may reduce risk, but clinical trials are needed to examine the effectiveness of such interventions.

Adult↗

PubMed1999

Cohabitation in Western Europe.

This article examines for a range of European countries: the extent to which men and women are not forming partnerships and how this has changed over time; the number of partnerships experienced; type of first partnership in terms of whether it commences with marriage or cohabitation and, if the latter, whether it converts into marriage; as well as the duration of different types of cohabiting unions. It also includes an examination of the risk of breakdown amongst first unions that commence with cohabitation or marriage and the variations in type of first union according to background characteristics, including: educational attainment, religious observance and experience of parental divorce in childhood.

Adult↗

PubMed1999

Childbearing outside marriage in western Europe.

Across most European states in recent decades there have been significant increases in childbearing outside marriage. This article examines the extent to which women have their first child in one of four settings: prior to any partnership; in their first cohabiting partnership; in first marriage; and after a first partnership. Temporal changes in these behaviours and variation according to background characteristics of the women are also examined. For the women who had a child outside any partnership, we examine the extent to which they go on to form partnerships and how long after the birth this happens. For those who had their first child within a cohabiting union, we examine the extent to which they marry and how long after the birth this occurs. Finally, we investigate whether children born within cohabiting unions that do and do not convert into marriages are more or less likely than those born within marriage to see their parents separate.

Adult↗

PubMed1989

Occupational therapy program development for medical-psychiatry units: a cognitive model.

Occupational therapy programs form an essential component of the overall treatment program on medical psychiatry units for patients with depression, physical debilitation, and cognitive dysfunction. This article outlines theoretical and practical aspects of developing an occupational therapy program for medical-psychiatric inpatients. Emphasis is placed on accurate assessment of cognitive and physical functioning to facilitate stratification of patients into appropriate therapeutic activities that are commensurate with their level of functioning. The theoretical basis and orientation of occupational therapy is also discussed vis-à-vis its relevance to the treatment of patients with concurrent medical and psychiatric illness.

Adolescent↗

PubMed1986

Cold-restraint stress reduces [3H]etorphine binding to rat brain membranes: influence of acute and chronic morphine and naloxone.

[3H]Etorphine binding was characterized in rat brain homogenates depleted of endogenous opioids from animals acutely and chronically treated with morphine or naloxone and either unstressed or subjected to a 3-h restraint period in the cold. There was significant reduction in the number of high-affinity opiate binding sites in brain tissue from stressed as compared to unstressed animals. Despite the fact that the opiate drug regimens used produce marked behavioral and physiological effects, stress-induced opiate receptor depletion was not influenced by the drugs or by withdrawal. The various drug treatments also failed to produce significant changes in opiate receptor site densities or affinities in either stressed or unstressed animals. We propose that persistent activation of opiate receptors by endogenous opioids released during restraint stress leads to receptor 'down-regulation'.

Animals↗

PubMed1986

Effects of morphine and naloxone on stress ulcer formation and gastric acid secretion.

The effect of both acute and chronic morphine and naloxone on restraint-stress gastric ulcer formation and on basal gastric acid secretion were examined in the conscious rat. Acute morphine administration produced a dose-related decrease in stress ulceration and basal gastric acid secretion. Acute naloxone treatment resulted in a dose-related increase in stress ulcer formation and markedly augmented gastric acid secretion. Naloxone (4.0 mg/kg) antagonized the ulcer-reducing effects at all doses of morphine tested (4.0-32.0 mg/kg). Morphine-dependent rats, restrained during spontaneous or naloxone-precipitated withdrawal, exhibited the most severe ulceration. However, only those subjected to naloxone-precipitated withdrawal produced a significant increase in gastric acid output. Chronic treatment with naloxone or with chronic naloxone followed by morphine (16.0 mg/kg) resulted in augmented stress ulcer formation relative to all acutely treated groups. Both chronic naloxone-treated groups exhibited markedly enhanced gastric secretion. These data suggest that central and/or peripheral opiate receptors can modulate both basal and stress-perturbed gastric function.

Animals↗

PubMed1984

Bulimia.

Explore the source record for details and available documents.

Adolescent↗

PubMed1976

Personality scores and smoking behaviour. A longitudinal study.

The personality scores at 16 years of age of 2753 people, all members of the National Survey of Health and Development, were related, in a follow-up study, to cigarette smoking behaviour in their young adult years. Survey members who recorded high neuroticism scores were found to be more likely to smoke than those with low scores and, among the smokers, deep inhalers formed the most neurotic group. Extraverts were more likely to smoke than introverts, the mean extraversion score being greatest for the male smokers with a high daily consumption of cigarettes. The personality scores were found to have some power in predicting changes in smoking behaviour. Neurotics and extraverts who had not started to smoke by the time of completing the personality inventory at 16 were more likely than the stable and introverted to take up the habit subsequently. Among survey members who were regular smokers at the time of completing the personality inventory the proportion giving up smoking by the time they reached the age of 25 years was related to consumption level recorded at 20 years and the personality scores recorded at 16, stable extraverts among the men being most likely to stop smoking.

Adolescent↗

PubMedDate not supplied

Factors affecting anxiety and depression in psychiatric consultation patients.

Factors that contribute to dysphoric affects in patients seen on a consultation-liaison service were investigated. Eighty-five subjects were studied to assess the role of character style, locus of control and seriousness of medical illness upon the magnitude of depression and anxiety each patient experienced. Results indicated that the obsessoid individual as well as individuals in pain reported significantly more depression and anxiety than their hysteroid counterparts. The severity of illness did not correlate with greater dysphoria. Those individuals who were more externally located were found to be in greater subjective pain. Furthermore, psychiatric consultants significantly tended to ignore the issue of the pain more often than anxiety and depression. The implications of these findings are discussed as they relate to a patient's personality style and the experience of illness and hospitalization.

Adult↗