Anthony Kinsella

Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland

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Publications (195)807.32 Total impact

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    ABSTRACT: Individuals with psychotic disorders are represented more in the lower social classes, yet there is conflicting evidence to whether these individuals drift into the lower social classes or whether lower social class is a risk factor for developing psychosis. The aim of this study was to examine whether the social class at birth is a risk factor for developing psychosis. We included individuals with a first episode of psychosis (FEP) whose social class at birth was determined from birth records. We employed a case-control study design and also compared the distribution of the social classes at birth of the cases to that of the general population. A total of 380 individuals with an FEP and 760 controls were included in the case-control study. The odds ratio for developing an FEP associated with social class (low vs high) was .62 (95% confidence interval (CI): .46-.85, p < .001), indicating that individuals from a lower social class at birth have a reduced risk of psychosis. Individuals born between 1961 and 1980 with an FEP were more likely to be from a higher social class at birth compared to the general population (60.8% vs 36.7%, χ(2) = 60.85, df = 1, p < .001). However, this association was not observed for those born between 1981 and 1990. A higher social class at birth is associated with a greater risk for developing a psychotic disorder; however, this effect may show temporal variation. © The Author(s) 2015.
    International Journal of Social Psychiatry 04/2015; DOI:10.1177/0020764015581434 · 1.15 Impact Factor
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    ABSTRACT: Background Psychotic disorders are associated with a significant impairment in occupational functioning that can begin in the prodromal phase of the disorder. As a result, individuals with a psychotic disorder may not maintain their social class at birth. The aim of this study was to examine the distribution of the social classes of individuals presenting with a first episode of psychosis (FEP) compared to the general population and to their family of origin. We evaluated whether social drift was associated with depression, hopelessness and suicidality at first presentation. Methods All individuals with a FEP presenting to a community mental health service between 1995 and 1999 and to an early intervention service between 2005 and 2011were included. Diagnosis was established using the Structured Clinical Interview for DSM IV diagnoses and clinical evaluations included the Calgary Depression Scale for Schizophrenia, Beck Hopelessness Scale and the Suicidal Intent Scale. Results 330 individuals were included in the study and by the time of presentation, individuals with a FEP were more likely to be represented in the lower social classes compared to the general population. 43% experienced a social drift and this was associated with a diagnosis of a non-affective disorder, co-morbid cannabis abuse and a longer DUP. Individuals who did not experience a social drift had a higher risk of hopelessness. Conclusions Social drift is common in psychotic disorders; however, individuals who either maintain their social class or experience upward social class mobility are more susceptible to hopelessness.
    Schizophrenia Research 08/2014; 157(1-3). DOI:10.1016/j.schres.2014.05.022 · 4.43 Impact Factor
  • Schizophrenia Research 04/2014; 153:S286. DOI:10.1016/S0920-9964(14)70811-4 · 4.43 Impact Factor
  • Schizophrenia Research; 04/2014
  • Schizophrenia Research 04/2014; 153:S295-S296. DOI:10.1016/S0920-9964(14)70835-7 · 4.43 Impact Factor
  • Schizophrenia Research; 04/2014
  • Schizophrenia Research 04/2014; 153:S231-S232. DOI:10.1016/S0920-9964(14)70666-8 · 4.43 Impact Factor
  • Schizophrenia Research; 04/2014
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    ABSTRACT: Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables-namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature-influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.
    International Journal of Biometeorology 03/2014; 58(10). DOI:10.1007/s00484-014-0805-9 · 2.10 Impact Factor
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    ABSTRACT: Previous studies in schizophrenia samples suggest negative symptoms can be categorized as expressivity or experiential. This study examines the structure of the Scale for the Assessment of Negative Symptoms (SANS) at two separate interviews in a first episode psychosis (FEP) sample. SANS structure was determined with principal components analysis in a schizophrenia spectrum (SSD, N=191) and non-schizophrenia spectrum (NSSD, N=246) sample at first presentation. Confirmatory factor analysis (CFA) was conducted in the entire FEP sample (N=197) at a follow-up assessment. A three factor model solution was extracted in both SSD and NSSD at first presentation. The three components, consisting of expressivity, experiential and alogia/inattention components, explained 26.1%, 16.6% and 13.6% of the variance respectively in SSD. In NSSD the same three components explained 24.2%, 17.9% and 13.1% of the variance respectively. CFA at follow-up showed similar model fit for both the original SANS five factor and for a three factor model solution. The results indicate that either a three or five factor SANS model solution may be appropriate in a psychosis sample inclusive of both SSD and NSSD. The findings also provide initial support for expressivity and experiential domain research in NSSD.
    10/2013; 210(3). DOI:10.1016/j.psychres.2013.09.008
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    ABSTRACT: To investigate the role of glutamate receptor subtypes and γ-aminobutyric acid (GABA) in orofacial function, six individual topographies of orofacial movement, both spontaneous and induced by the dopamine D1-like receptor agonist SKF 83959, were quantified in mutant mice with deletion of (a) GluN2A, B or D receptors, and (b) the GABA synthesising enzyme, 65-kD isoform of glutamate decarboxylase (GAD65). In GluN2A mutants, habituation of head movements was disrupted and vibrissae movements were reduced, with an overall increase in locomotion; responsivity to SKF 83959 was unaltered. In GluN2B mutants, vertical and horizontal jaw movements and incisor chattering were increased, with an overall decrease in locomotion; under challenge with SKF 83959, head and vibrissae movements were reduced. In GluN2D mutants, horizontal jaw movements, incisor chattering and vibrissae movements were increased, with reduced tongue protrusions and no overall change in locomotion; under challenge with SKF 83959, horizontal jaw movements were increased. In GAD65 mutants, vertical jaw movements were increased, with disruption to habituation of locomotion; under challenge with SKF 83959, vertical and horizontal jaw movements and incisor chattering were decreased. Effects on orofacial movements differed from their effects on regulation of overall locomotor behaviour. These findings (a) indicate novel, differential roles for GluN2A, B and D receptors and for GAD65-mediated GABA in the regulation of individual topographies of orofacial movement and (b) reveal how these roles differ from and/or interact with the established role of D1-like receptors in pattern generators and effectors for such movements.
    Neuroscience 07/2013; 250. DOI:10.1016/j.neuroscience.2013.07.038 · 3.33 Impact Factor
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    ABSTRACT: Quality of life (QOL) is now recognised as an important measure of outcome that could potentially influence clinical decision-making for those with a first-episode psychosis (FEP). A number of QOL instruments are available however; many differ in their conceptual orientation which may have serious implications for the outcome of QOL studies, interpretation of findings and clinical utility. We aimed to compare two commonly used tools representing both generic and disease-specific constructs to examine whether both tools appraise the same underlying QOL traits and also whether disease-specific tools retain their psychometric properties when used in FEP groups. We assessed 159 consecutive individuals presenting with FEP in a defined catchment area with two commonly used QOL tools and examined the findings using the multi-trait multi-method matrix. Similarly named domains of QOL between both tools (Psychological Wellbeing, Physical Health, Social Relations) showed good convergent validity using confirmatory factor analysis. However, discriminant validity was not established given that domains loading onto their indicated latent factors were more strongly correlated with their non-corresponding latent factors. A major consideration in undertaking the present study was to assess the extent to which the outcome of QOL studies in FEP were valid and that systematic error did not provide another plausible explanation for findings. Establishing convergent validity demonstrates that either tool could be used satisfactorily to measure the QOL construct identified however; we did not establish discriminant validity. Doing so would have demonstrated that QOL domains are substantively different in that they contain some unique piece of information determining clinical utility. These findings are important for our understanding of multi-dimensional models of QOL.
    Journal of Psychiatric Research 07/2013; 47(10). DOI:10.1016/j.jpsychires.2013.06.001 · 4.09 Impact Factor
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    ABSTRACT: Early intervention (EI) services for psychosis aim to reduce the duration of untreated psychosis (DUP) with intensive large-scale multi-focus initiatives, including public awareness campaigns. As a consequence of this approach, individuals with a very long DUP who might have otherwise remained undiagnosed may come to medical attention. The aim of this study was to investigate if an EI service detected additional cases of individuals with a first-episode psychosis (FEP) with a very long DUP and identify demographic and clinical characteristics associated with a very long DUP. We compared the distribution of the DUP in cases with FEP in a cohort from an EI service in a geographically defined catchment area with a historical control group. Participants were interviewed using the Structured Clinical Interview for DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnoses and the Beiser scale to determine the DUP. A total of 172 individuals were included in the EI service and 151 were included from the historical control. There was no difference in the distribution of the DUP in the EI service compared with the historical control group (χ(2) = 3.77, degrees of freedom (d.f.) = 3, P = 0.29). In the EI service, 7.6% of cases had a DUP between 24 and 35.9 months compared to 3.3% in the historical control, and 13.4% of cases in the EI service had a DUP of greater than three years compared to 10.6% in the historical control. A very long DUP was associated with unemployment, less insight and involuntary treatment. Further examination of the pathways to care in cases with a long DUP may clarify the contribution of help-seeking and health system delays for these individuals.
    Early Intervention in Psychiatry 06/2013; 8(4). DOI:10.1111/eip.12063 · 1.74 Impact Factor
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    ABSTRACT: AIM: We examined whether it is possible to use a television programme to improve mental health literacy about schizophrenia by investigating the impact of the introduction of a realistic portrayal of schizophrenia into a popular television soap opera. METHOD: A population level omnibus survey method was used. A market research company conducted face-to-face interviews with a representative sample of the Irish population (n = 993). A specifically developed questionnaire was used which included a question on the extent to which the relevant television programme was watched. A grouping variable 'viewers/non-viewers' was then created. Groups were subsequently compared for differences in demographic characteristics, mental health literacy and attitudes towards schizophrenia. RESULTS: Of the sample, 370 were regarded as viewers. When compared, viewers and non-viewers did not differ on demographic characteristics but there were significant differences between the groups in both knowledge and attitudes regarding schizophrenia. Viewers were better informed on where to go for help and were more optimistic regarding the likelihood of recovery. However, on a question regarding willingness to have an intimate relationship with someone with a previous history of mental illness, viewers had greater concerns than non-viewers. CONCLUSION: It is possible to use television dramas to educate the public about mental illnesses. Piloting of the educational material may offer an opportunity to refine the storyline so that the relevant messages are clearly communicated.
    Early Intervention in Psychiatry 06/2013; DOI:10.1111/eip.12056 · 1.74 Impact Factor
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    ABSTRACT: While recent research on psychotic illness has focussed on the nosological, clinical, and biological relationships between schizophrenia and bipolar disorder, little attention has been directed to the most common other psychotic diagnosis, major depressive disorder with psychotic features (MDDP). As this diagnostic category captures the confluence between dimensions of psychotic and affective psychopathology, it is of unappreciated heuristic potential to inform on the nature of psychotic illness. Therefore, the epidemiology and clinical characteristics of MDDP were compared with those of schizophrenia and bipolar disorder within the Cavan-Monaghan First Episode Psychosis Study (n = 370). Epidemiologically, the first psychotic episode of MDDP (n = 77) was uniformly distributed across the adult life span, while schizophrenia (n = 73) and bipolar disorder (n = 73) were primarily disorders of young adulthood; the incidence of MDDP, like bipolar disorder, did not differ between the sexes, while the incidence of schizophrenia was more common in males than in females. Clinically, MDDP was characterized by negative symptoms, executive dysfunction, neurological soft signs (NSS), premorbid intellectual function, premorbid adjustment, and quality of life similar to those for schizophrenia, while bipolar disorder was characterized by less prominent negative symptoms, executive dysfunction and NSS, and better quality of life. These findings suggest that what we currently categorize as MDDP may be more closely aligned with other psychotic diagnoses than has been considered previously. They indicate that differences in how psychosis is manifested vis-à-vis depression and mania may be quantitative rather than qualitative and occur within a dimensional space, rather than validating categorical distinctions.
    Schizophrenia Bulletin 05/2013; DOI:10.1093/schbul/sbt075 · 8.61 Impact Factor
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    ABSTRACT: BACKGROUND: Negative symptoms have been previously reported during the psychosis prodrome, however our understanding of their relationship with treatment-phase negative symptoms remains unclear. OBJECTIVES: We report the prevalence of psychosis prodrome onset negative symptoms (PONS) and ascertain whether these predict negative symptoms at first presentation for treatment. METHODS: Presence of expressivity or experiential negative symptom domains was established at first presentation for treatment using the Scale for Assessment of Negative Symptoms (SANS) in 373 individuals with a first episode psychosis. PONS were established using the Beiser Scale. The relationship between PONS and negative symptoms at first presentation was ascertained and regression analyses determined the relationship independent of confounding. RESULTS: PONS prevalence was 50.3% in the schizophrenia spectrum group (n=155) and 31.2% in the non-schizophrenia spectrum group (n=218). In the schizophrenia spectrum group, PONS had a significant unadjusted (χ(2)=10.41, P<0.001) and adjusted (OR=2.40, 95% CI=1.11-5.22, P=0.027) association with first presentation experiential symptoms, however this relationship was not evident in the non-schizophrenia spectrum group. PONS did not predict expressivity symptoms in either diagnostic group. CONCLUSION: PONS are common in schizophrenia spectrum diagnoses, and predict experiential symptoms at first presentation. Further prospective research is needed to examine whether negative symptoms commence during the psychosis prodrome.
    European Psychiatry 03/2013; DOI:10.1016/j.eurpsy.2013.02.003 · 3.21 Impact Factor
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    ABSTRACT: BACKGROUND: The boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions. Method The Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency. RESULTS: Over 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria. CONCLUSIONS: CAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.
    Psychological Medicine 03/2013; 43(12):1-11. DOI:10.1017/S003329171300041X · 5.43 Impact Factor
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    ABSTRACT: BACKGROUND: Patients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population. AIMS: We undertook a multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence to determine whether there was any impact on cannabis use symptoms, global functioning, insight, attitudes to treatment and subjective quality of life. METHOD: Across three centers, we compared a group psychological intervention, based on cognitive behavioral therapy and motivational interviewing, with treatment as usual among patients experiencing their first psychotic episode or early in the course of psychotic illness. Substance misuse and indices of clinical outcome were assessed at baseline, 3months and 1year. RESULTS: At 3month and 1year follow-ups, there was no evidence for an intervention effect on cannabis use, symptoms, global functioning insight or attitude to treatment. However, the intervention improved subjective quality of life at 3months and this effect was sustained at 1year. CONCLUSIONS: Over the early phase of psychotic illness, group psychological interventions for those with comorbid cannabis dependence improved subjective quality of life. However, this was not associated with reduction in use of cannabis or improvement in clinical outcomes.
    Schizophrenia Research 11/2012; 143(1). DOI:10.1016/j.schres.2012.10.018 · 4.43 Impact Factor
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    ABSTRACT: Background The duration of untreated psychosis is well recognised as an independent predictor of symptomatic and functional outcome in the short term and has facilitated the development of worldwide early intervention programmes. However, the extent and mechanisms by which it might influence prognosis beyond a decade remain poorly understood.Methods The authors examined the relationship between duration of untreated psychosis and outcome 12 years after a first episode of psychosis and assessed whether its relationship with function is affected by symptoms in a prospective, 12-year follow-up of an epidemiologically-based inception cohort.ResultsLonger duration of untreated psychosis predicted poorer remission status, more severe positive and negative symptoms, and greater impairment in general functioning, social functioning and quality of life at 12 years on standardised measures, independent of other factors at baseline. It was not associated with gainful employment, for which education was the only predictor, or independent living, for which age was the only predictor. The relationship between duration of untreated psychosis and functional outcome was mediated by concurrent psychopathology, particularly negative symptoms.Conclusions These results provide qualified support for the potential long-term benefit of reduction in the duration of untreated psychosis in terms of improvement in symptoms and functional outcome. Its failure to predict real-life outcomes such as independent living and gainful employment could reflect the importance of pre-existing socio-cultural factors such as individual opportunity. The relationship between duration of untreated psychosis and negative symptoms was largely responsible for its effect on function, suggesting a possible long-term protective mechanism against disability.
    Schizophrenia Research 11/2012; 141(2-3-2–3):215-221. DOI:10.1016/j.schres.2012.08.013 · 4.43 Impact Factor
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    ABSTRACT: Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.
    International Journal of Biometeorology 08/2012; DOI:10.1007/s00484-012-0575-1 · 2.10 Impact Factor

Publication Stats

4k Citations
807.32 Total Impact Points


  • 1987–2013
    • Royal College of Surgeons in Ireland
      • • Department of Molecular and Cellular Therapeutics
      • • Department of Clinical Pharmacology
      Dublin, Leinster, Ireland
    • St. Loman’s Hospital, Mullingar
      Tulach Mhór, Leinster, Ireland
  • 2011
    • Ireland's Health Services
      Dublin, Leinster, Ireland
  • 2006–2011
    • University College Dublin
      • School of Nursing, Midwifery and Health Systems
      Dublin, Leinster, Ireland
    • Saint John of God Hospitaller Services
      Dublin, Leinster, Ireland
    • McGill University
      Montréal, Quebec, Canada
  • 2009
    • 1st Detect
      Webster, Texas, United States
  • 2008–2009
    • St John of God Hospital
      Dublin, Leinster, Ireland
    • University of Cologne
      • Department of Psychiatry and Psychotherapy
      Köln, North Rhine-Westphalia, Germany
  • 1989–2006
    • Dublin Institute of Technology
      • School of Biological Sciences
      Dublin, Leinster, Ireland
  • 2004
    • The Rockefeller University
      New York, New York, United States
  • 2000
    • St. James's Hospital
      Dublin, Leinster, Ireland
    • Monash University (Australia)
      • Centre for Reproduction and Development
      Melbourne, Victoria, Australia
    • Lund University
      Lund, Skåne, Sweden
  • 1998–2000
    • Cavan Monaghan Hospital
      Monaghan, Ulster, Ireland
  • 1991
    • Trinity College Dublin
      Dublin, Leinster, Ireland