Cognitive behavioural therapy (CBT) is effective for symptoms of mild to moderate depression yet access to such therapy is frequently limited. An alternative to traditional ways of delivering CBT is lower intensity methods based on self-help principles, using written CBT resources, in a group or class setting. Aware, the Irish National charity providing support to people experiencing depression, has implemented a 6-week CBT-based group programme which has been independently evaluated to demonstrate its effectiveness using quantitative and qualitative measures.

Two outcome measures (the Patient Health Questionnaire – PHQ-9, and Generalised Anxiety Disorder – GAD-7) were completed and analysed using a matched pairs t-test in respect of all participants at three intervals across the programme. Qualitative feedback was also sought upon completion of the course and offered insight into significant change and individual impact of the programme.

A total of 2289 individuals nationwide registered for the programme through the Aware website with 1885 completing the 6 weeks. There was an average attendance of 67% for the 6-week programme. Statistically significant reductions in terms of scores of depression and anxiety were seen upon completion but earlier trends towards improvement were noted.

Completion of a 6-week Life Skills Programme has been associated with a reduction from moderately severe to mild scores in relation to both depressive and anxiety symptoms. Longitudinal follow-up will be required to determine if the effectiveness of the intervention is maintained but CBT-based group programmes may represent a useful alternative to traditional services to treat clinically significant depression.

Recovery is a key goal for individuals, and services’ recovery orientation can facilitate this process. The independent mental health sector is increasingly important in Ireland, particularly in counselling and suicide prevention. We aimed to evaluate Pieta House as a recovery-oriented service through clients’ self-rated recovery; and clients’ and therapists’ evaluation of the service.

Clients completing therapy over a 3-month period were invited to complete the Recovery Assessment Scale (RAS) and the Recovery Self Assessment-Revised (RSA-R). Therapists completed the RSA-R staff version.

Response rate was 36.7% for clients (n=88), 98% for therapists (n=49). Personal recovery was endorsed by 73.8% of clients, with highest agreement for factors ‘Willingness to Ask for Help’ (84.5%), and ‘Reliance on Others’ (82.1%). A smaller number agreed with factors ‘Personal Confidence and Hope’ (61.3%) and ‘No Domination by Symptoms’ (66.6%). Clients’ and therapists’ evaluation of the service showed high levels of agreement with factors of ‘Choice’ (90.9% clients, 100% therapists); ‘Life Goals’ (84.1% clients, 98% therapists) and ‘Individually Tailored Services’ (80.6% clients, 79.6% therapists). Client involvement in service management had the lowest level of agreement (36.4% clients, 30.6% therapists). Clients’ self-rated recovery correlated with their rating of the service (correlation value 0.993, p=0.01).

Clients’ self-rated recovery and the recovery orientation of Pieta House were rated highly, with areas for improvement in service user involvement, peer support and advocacy. The correlation of personal recovery and recovery orientation of the service may merit further study.

There are conflicting reports on the levels of anxiety and depression in individuals with alcohol problems and whether these conditions are substance-related or independent of the alcohol problem. The aim of this study was to characterise rates of co-morbid psychiatric symptoms among a group of individuals commencing treatment for alcohol dependence, and to examine the stability of these symptoms following treatment of the alcohol problem.

Symptoms of anxiety and depression were examined in a group of individuals (n=93) undergoing residential treatment for alcohol dependence. Symptoms were measured at treatment entry and again at treatment completion using the Beck Anxiety Inventory and the Beck Depression Inventory – II.

High levels of anxiety and depressive symptoms were reported at treatment entry, but on completion of treatment (28 days later) the majority of participants were no longer reporting symptoms suggestive of a possible co-morbid condition.

The significant change in rates of reported symptoms following completion of treatment suggests that a large proportion of symptoms reported at treatment entry were substance related. Diagnosing co-morbid conditions is best left until after a period of abstinence during which the alcohol problem has been treated. Assessing for co-morbidity at time of treatment seeking is likely to result in inappropriate co-morbid diagnoses being made and inappropriate or unnecessary treatments being prescribed for such individuals.

The Khyber Pakhtunkhwa province of North-West Pakistan has endured increased levels of violence in recent years. The psychological sequelae of such trauma including the presence of dissociative symptoms has been minimally investigated to date. The study examines psychopathology experienced including the presence of dissociative symptoms, and ascertain what factors are potentially predictive of these symptoms.

Third-level students (n=303) completed psychometric instruments relating to their experience of traumatic events and assessed depression, anxiety and dissociative symptoms.

Symptoms suggestive of post-traumatic stress disorder were evident in 28% of individuals. Symptoms relating to intrusive experiences and alterations in reactivity predicted dissociative, depressive and anxiety symptoms (p<0.01).

Trauma related to violence in this study was associated with significant pathology including dissociative symptoms. Identification and subsequent treatment of dissociative symptoms in individuals who have experienced trauma, may have a significant ameliorating effect on levels of functioning and thus should be included in clinical assessment.

We sought to identify and review published studies that discuss the ethical considerations, from a physician’s perspective, of managing a hunger strike in a prison setting.

A database search was conducted to identify relevant publications. We included case studies, case series, guidelines and review articles published over a 20-year period. Non-English language publications were translated.

The review found 23 papers from 12 jurisdictions published in five languages suitable for inclusion.

Key themes from included publications are identified and summarised in the context of accepted guidelines from the World Medical Association. Whilst there seems to be an overall consensus favouring autonomy over beneficence, tensions along this fine balance are magnified in jurisdictions where legislation leads to a dual loyalty conflict for the physician.