Does Lent affect rates of deliberate self-harm?

BACKGROUND: Research has shown that religious affiliation has a protective effect against deliberate self-harm. This is particularly pronounced in periods of increased religious significance, such as periods of worship, celebration, and fasting. However, no data exist as to whether this effect is present during the Christian period of Lent. Our hypothesis was that Lent would lead to decreased presentations of self-harm emergency department (ED) in a predominantly Catholic area of Ireland. METHODS: Following ethical approval, we retrospectively analysed data on presentations to the ED of University Hospital Limerick during the period of Lent and the 40 days immediately preceding it. Frequency data were compared using Pearson's chi-squared tests in SPSS. RESULTS: There was no significant difference in the overall number of people presenting to the ED with self-harm during Lent compared to the 40 days preceding it (χ2 = 0.75, df = 1, p > 0.05), and there was no difference in methods of self-harm used. However, there was a significant increase in attendances with self-harm during Lent in the over 50's age group (χ2 = 7.76, df = 1, p = 0.005). CONCLUSIONS: Based on our study, Lent is not a protective factor for deliberate self-harm and was associated with increased presentations in the over 50's age group. Further large-scale studies are warranted to investigate this finding as it has implications for prevention and management of deliberate self-harm.

Children, seen and heard: a descriptive study of all children (aged 12 years and under) referred for acute psychiatric assessment in Tallaght University Hospital over a 10-year period.

OBJECTIVES: A review of the literature demonstrates that relatively little is known about acute psychiatric presentations in children (0-12 years), compared with adolescents or young adults (12 years+). This study aims to review psychiatric presentations of children to a CAMHS Liaison Service at Children's Hospital Ireland (CHI) at Tallaght University Hospital over a 10-year period. METHODS: A retrospective study was undertaken of case notes of all children aged 12 years and under who were referred to the CAMHS Liaison Service between January 2009 and December 2018 (n = 318). Data were anonymised and inputted into SPSSv25 for analysis. The relationships between presentations and methods of self-harm over time were measured using Pearson's correlation. Associations between categorical variables were analysed using chi-squared tests. RESULTS: There was a significant increase in presentations of under-12s over the 10-year period (r(8)=0.66, p = 0.02). There was also a significant increase in children presenting with a disturbance of conduct and/or emotions over time (r(8) = 0.79, p < 0.001). There was a significant association between female gender and ingestion (X2 = 12.73, df = 1, p < 0.05) and between male gender and ligature as a method of self-harm (X2 = 5.54, df = 1, p < 0.05). Over half (53%) of children presented with suicidal thoughts and 22% presented with suicidal behaviours. The reported use of ligature as a method of self-harm emerged only from 2012 among cases studied. CONCLUSIONS: Children aged 12 years and under are presenting in increasing numbers with acute mental health difficulties, including suicidal thoughts and behaviours. There is a worrying trend in methods of self-harm, particularly in high lethality behaviours such as attempted strangulation.

Fallout from the COVID-19 pandemic - should we prepare for a tsunami of post viral depression?

The current COVID-19 pandemic is not just a medical and social tragedy, but within the threat of the outbreak looms the potential for a significant and persistent negative mental health impact, based on previous experience with other pandemics such as Severe Acute Respiratory Syndrome (SARS) in 2003 and the earlier H1N1 outbreak of 1918. This piece will highlight the links between depression and viral illnesses and explore important overlaps with myalgic encephalomyelitis/chronic fatigue syndrome, potentially implicating inflammatory mechanisms in those exposed to a range of viral agents. While containment of psychological distress currently focuses on social anxiety and quarantine measures, a second wave of psychological morbidity due to viral illness may be imminent.

Diagnosis-related group system. Can we still earn a living caring for sick people?

Medicare and Medicaid patients are starting to enroll in managed care organizations, as government tries to lower costs of caring for the elderly, disabled, and poor. Because they are the most likely to be sick, taking care of them imposes serious risks on hospitals and medical groups. The federal government uses the diagnosis-related group (DRG) system to reimburse hospitals. The system depends on physicians documenting diagnoses and complications. Physicians see illness as unpredictable, and so feel that detailed documentation of severity is futile. The government and health plans nevertheless follow case mix index and create hospital and physician profiles, relying on the existing imperfect system. For providers to be recognized for the value they add to the care of the sick, physicians must learn to use the DRG system to best advantage, or risk being driven out of business.

Exogenous lipoid pneumonia due to inhalation of spray lubricant (WD-40 lung).

An elderly woman developed lipoid pneumonia due to the inhalation of mist from a spray lubricant that she was using as a liniment for sore back and neck muscles. This unusual practice is reported to be common among older people bothered by rheumatism. The potential for this complication to occur in other patients leads us to present this case report.

The role of cigarettes in the initiation and progression of early substance use.

This study examined progression in substance use from initiation to eventual regular use and provided information on a number of levels. Cigarette use was shown to fall on a cumulative (Guttman) scale of use with other drugs (e.g., marijuana, beer, liquor, stimulants or depressants). Also, cigarettes were the drug with the youngest mean age of onset which would still fall on a Guttman scale with other drugs shown to scale in previous research. Finally, it was shown that having tried only cigarettes or marijuana made one significantly more likely to be using other drugs two years later.

The quitting experience for smokers in sixth through twelfth grades.

The present study examined the withdrawal process for adolescents who had attempted to quit smoking. A sample of 622 6th through 12th graders were interviewed. Smoking status was reported prior to attempting to quit and its relationship with the withdrawal experience was evaluated. Although over half of those who smoked regularly reported trying to quit, 78% of the "quitters" were smoking six months after their quit attempt. Experiencing adverse withdrawal symptoms was related to smoking at daily levels before quitting; delaying trying to quit was associated with initiation of smoking at an early age; and quitting success was predicted by early quitting age, lower pre-quitting smoking levels, a lack of a prior quitting failure, and peer smoking. The results suggest that smoking intervention programs for adolescents should include components facilitating the quitting process that take into consideration youngsters' smoking and quitting histories.

Is the smoking decision an 'informed choice'? Effect of smoking risk factors on smoking beliefs.

The argument that people freely choose to smoke assumes that individuals at the point of initiation of smoking (often in adolescence) hold accurate beliefs about smoking. Smoking beliefs and the presence of known smoking risk factors were assessed in interviews with a sample of 895 urban young people. The respondents greatly overestimated the prevalence of adult and peer smoking, negative attitudes of their peers were greatly underestimated, a large proportion believed that they would be less likely than other people to contract a smoking-related illness if they became smokers, and there was a general lack of understanding of the adverse consequences experienced upon smoking cessation. These misperceptions were more common among youngsters who were smokers, who intended to smoke, or who had friends or family members who smoked. Because misinformation among young people is widespread and those at greatest risk for smoking are the most misinformed, the tobacco industry's argument that the decision to smoke reflects an "informed choice" is without merit.

A cognitive developmental approach to smoking prevention.

Most smoking prevention programs for middle-schoolers target non-smokers. These programs seek to educate young people about the hazards of smoking, influence young peoples' attitudes toward smoking, and reduce initial experimentation with cigarettes by providing social- and life-skills training. The program described in this chapter incorporates these features and adds a component which explores, in some depth, the nature of the user's response to cigarettes. This component focuses on the young person's physical and psychological reaction to cigarette smoking, and provides a knowledge base which promotes a negative evaluation of that reaction. This component targets all young people, but it is anticipated that it will be especially effective with pre-addictive experimenters who are wondering what smoking can "do for them". One challenge for the future is the development of intervention strategies that have something to offer the young addicted smoker who wishes to quit smoking. These young people are largely unserved by school-based smoking education programs, drug abuse programs, and organized smoking therapies.