Mary Clarke

University College Dublin | UCD · Department of Psychiatry and Mental Health Research

Background: Migration is a robust risk factor for developing a psychotic disorder, yet there is a paucity of research on the outcomes of migrants who develop a psychotic disorder. Identifying sub-groups within FEP cohorts who have a poorer outcome, could assist in the development and delivery of more targeted interventions. Aims: There is a pauci...

Objective: Determining the extent to which relationships between duration of untreated psychosis (DUP) and outcome endure longitudinally across the lifetime course of psychotic illness requires prospective, systematic studies of epidemiologically representative incidence cohorts across decades. Transience, persistence, or heterogeneity in associati...

Background Migration is an established risk factor for developing a psychotic disorder in countries with a long history of migration. Less is known for countries with only a recent history of migration. This study aimed to determine the risk for developing a psychotic disorder in migrants to the Republic of Ireland. Methods We included all present...

Objectives When presenting with a first episode of psychosis (FEP), migrants can have different demographic and clinical characteristics to the native-born population and this was examined in an Irish Early Intervention for Psychosis service. Methods All cases of treated FEP from three local mental health services within a defined catchment area w...

Background: While research indicates that people with serious mental health conditions want to work, few studies have examined motivation and concerns associated with employment. Objectives: This study examined the work attitudes among two samples of Irish people with psychotic conditions, primarily schizophrenia. Methods: Data gathered throug...

Objectives Often referred to as psychotic experiences, unusual perceptual experiences, thoughts and beliefs (UPTBs) are not uncommon in youth populations. Phenomenological studies of these experiences are lacking. This study aimed to (1) describe the phenomenological characteristics of UPTBs in a sample of young adolescents and (2) explore how youn...

Background Psychotic experiences (PEs) are reported by a significant minority of adolescents and are associated with the development of schizophrenia and other psychiatric disorders in adulthood. Few modifiable protective factors have been identified to date. The aims of this study were to examine associations between a range of psychopathological,...

Objectives Migrant youths endure many challenges. Such challenges can be stressful and lead to psychological difficulties. We investigated the relationship between migration, psychopathology and stressful events in children and adolescents. We hypothesised that migrant youths would show higher levels of psychopathology and more stressful life event...

Objective. To create a brief, experiential educational intervention for undergraduate pharmacy students aimed at developing appropriate attitudes, knowledge, and skills for the delivery of recovery-focused pharmacy services to people with mental illness, and to elicit student perceptions of the value and impact of the intervention. Methods. A brief...

Little is known about how recovery oriented policy and legislative changes influence service users’ perceptions of mental health care over time. Although the recovery approach is endorsed in many countries, qualitative research examining its impact on service use experiences has been lacking. This study aimed to explore this impact as well as exper...

A vocational intervention for people attending an Irish Early Intervention for Psychosis Service. A two pronged intervention was designed and tested. It included a job retention programme for people who had not lost their vocational role and used IPS with this those who had.

Background Psychotic experiences (PEs) are common in childhood and have been associated with concurrent mental disorder and poorer global functioning. Little is known about the effects of childhood PEs on future functioning. We investigated the effects of childhood PEs on global functioning from childhood into early adulthood. Method Fifty‐six par...

There is increasing supportive evidence for the paradigm of early intervention in psychosis. International data have confirmed the superior cost effectiveness of specialised early psychosis programmes in comparison to standard public mental health services. The role of Duration of Untreated Psychosis (DUP) in outcome in psychotic illness is now est...

Background There has been a surge of interest into the relationship between psychotic experiences (PEs) and bullying. However, the methods of bullying and impact of bullying varies across individuals and the prevalence may also vary by respondent (parent or children). For this reason, a thorough investigation into this relationship is warranted. M...

Background Individuals with schizophrenia show significant brain morphological abnormalities. The ENIGMA consortium identified that patients with schizophrenia had smaller hippocampus, amygdala, thalamus, accumbens and intracranial volumes.1 Reduced hippocampal volume is one of the most consistent findings in schizophrenia research.2–4 Also, Previo...

Background Existing literature suggests that prenatal stress may be a risk factor for offspring psychiatric disorders. For example, large ecological studies have found that those exposed to stressors during gestation, such as war and famine, have a twofold increase risk of schizophrenia, as well as an increased risk for other affective disorders. S...

Aim: Negative symptoms are a cause of enduring disability in serious mental illness. In spite of this, the development of effective treatments for negative symptoms has remained slow. The challenge of improving negative symptom outcomes is compounded by our limited understanding of their aetiology and longitudinal development. Methods: A literat...

Introduction The aim of this review was to conduct a meta-synthesis of qualitative studies examining the meaning of recovery and influences on recovery from the perspective of people diagnosed with ‘psychotic illness’. Due to the substantive difference between the experience of ‘psychotic illness’ and other types of ‘mental illness’ and the absence...

Objectives The findings of increased risk of physical health problems in those with schizophrenia and other psychoses, has deemed the systematic physical health monitoring an essential component of treatment in this vulnerable population. Physical health problems include weight gain, hypertension and metabolic syndrome. Genetic risk factors along w...

Background Diminished social networks are common in psychosis but few studies have measured these comprehensively and prospectively to determine how networks and support evolve during the early phase. There is little information regarding perceived support in the early phase of illness. The aim of this study was to describe social support, networks...

Purpose/background: For approximately one third of individuals treated for psychosis or schizophrenia, antipsychotic medications will have little or no therapeutic benefit. Clozapine remains the sole medication approved for treatment-resistant schizophrenia, and studies have demonstrated its superior efficacy in reducing psychotic symptoms. Metho...

Aim: Although the relationships between duration of untreated psychosis (DUP) and outcomes are often assumed to be linear, few studies have explored the functional form of these relationships. The aim of this study is to demonstrate the potential of recent advances in curve fitting approaches (splines) to explore the form of the relationship betwe...

Background: Understanding social inclusion among at-risk populations will deepen our understanding of their specific needs. Aim: This study explored the level of social inclusion among people with psychotic-related conditions using a standardised interview. Method: The Social Inclusion Interview Schedule was used in two research projects. Peop...

Background Previous magnetic resonance imaging (MRI) research suggests that, prior to the onset of psychosis, high risk youths already exhibit brain abnormalities similar to those present in patients with schizophrenia. Objectives The goal of the present study was to describe the functional organization of endogenous activation in young adolescent...

The aim of this study was to assess the feasibility of a psychosis information intervention for professionals in contact with young people in Ireland. A quasi-experimental pre-and post-intervention design was used. One thousand and thirty-two professionals received an information intervention designed to improve mental health literacy (MHL) and con...

Objectives Clinical practice guidelines (CPGs) support the translation of research evidence into clinical practice. Key health questions in CPGs ensure that recommendations will be applicable to the clinical context in which the guideline is used. The objectives of this study were to identify CPGs for the pharmacological treatment of first-episode...

Purpose: The literature has demonstrated the complexity of the concept of recovery in the context of ‘psychotic illness’. Much can be learned from qualitative explorations of recovery from the viewpoint of the service user. Materials and Methods: A systematic review and meta-synthesis were undertaken to synthesise the findings of qualitative studie...

Purpose: Internationally, the delivery of mental health services has changed dramatically over the last 20 years. In Ireland, this transformation is instantiated by the national policy document A Vision for Change (2006). This policy shift is underpinned by a recovery orientated approach which emphasises: service user and family/carer/supporter inv...

Background: Formal thought disorder (FTD) is associated with poor outcome in established psychotic illnesses and it can be assessed as a categorical or dimensional variable. However, its influence on functional outcome and hospitalisation patterns in early psychosis has not been investigated. We evaluated the relationship between FTD and these out...

Aim: Although early intervention in psychosis is an accepted policy internationally, the evidence base for this paradigm, originates mostly from the specialist model. In a real world setting, variations of this model are often implemented. The aim of this paper is to systematically evaluate the evidence for delivering early intervention outside th...

Background The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood level factors may influence this variation. It is also plausible that the DUP is associated with neighbourhood characteristics. The aims of this study are to determine whether the incidence of FEP and the DUP are associa...

A clinical trial of individual placement and support and a job retention programme at the DETECT Early Intervention for Psychosis Service. Conducted by Niall Turner Occupational Therapist.

Language disturbance has a central role in the presentation of psychotic disorders however its relationship with functioning requires further clarification, particularly in first episode psychosis (FEP). Both language disturbance and functioning can be evaluated with clinician-rated and performance-based measures. We aimed to investigate the concur...

Background: There is an unclear relationship between mental health literacy (MHL) and psychiatric stigma. MHL is associated with both positive and negative attitudes to mental illness. To our knowledge, no published peer reviewed study has examined this relationship in the Republic of Ireland. Aims: This study was conducted to assess MHL regardi...

The authors developed and validated a clozapine-specific side-effects scale capable of eliciting the subjectively unpleasant side-effects of clozapine. Questions from the original Glasgow Antipsychotic Side-effects Scale (GASS) were compared to a list of the most commonly reported clozapine side-effects and those with a significant subjective burde...

Abstract BACKGROUND: Early intervention in psychosis is an accepted policy internationally. When 'A Vision for Change', the national blueprint for mental health policy in Ireland, was published in 2007 there was one Irish pilot service for early intervention in psychosis. The National Clinical Mental Health Programme Plan (2011) identified early in...

Objective Wellness Recovery Action Planning (WRAP) is a cross-diagnostic, patient-centred, self-management intervention for psychiatric illness. WRAP utilises an individualised Wellness Toolbox, a six part structured monitoring and response system, and a crisis and post-crisis plan to promote recovery. The objective of this study was to evaluate th...

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...

Objectives. Study of illness characteristics and symptoms in a young population with psychosis can assist for under-standing of their needs, and can inform service planning strategies. The aims of the current study were to describe illness characteristics and symptoms of a first episode psychosis (FEP) sample aged 25 years and under, and compare wi...

Reducing the impact of the metabolic syndrome in schizophrenia using a Tailored Recovery Action in the Community (TRAC) Approach. Poster C64, Wednesday, November 19, 11:30 am - 12:40 pm, Hana Kevin Madigan1,2, Pauline Joyce2, Mary Clarke1,3;1Detect Early Intervention in Psychosis Service, 2Royal College of Surgeons in Ireland, 3University College...

Background Access to high quality information on psychosis is imperative to enable the understanding of the nature, likely course and available treatments for psychosis for patients and carers. Such information is closely correlated with better outcomes. Health literacy refers to the level of ability to access, process and utilise valid health info...

It is widely acknowledged that there is interplay between physical and mental health, with causality in both directions. A common theme across countries is the uncertainty surrounding who should act as gatekeeper for physical health matters in psychiatry. Much of the metabolic monitoring is carried out by psychiatrists who often feel ill equipped t...

Background: Authors of the Diagnostic and Statistical Manual, Fifth Edition (DSM-V) have recommended to “integrate dimensions into clinical practice.” The epidemiology and associated phenomenology of formal thought disorder (FTD) have been described but not reviewed. We aimed to carry out a systematic review of FTD to this end. Methods: A systemati...

Aims: Public education may constitute an effective early intervention strategy to reduce delays in the treatment of psychotic disorders and thereby improve outcome. The purpose of this project was to design, implement and validate a curriculum on early intervention in psychosis for youth workers. Method: A training intervention on early interven...

Purpose: Suicide is a leading cause of death among adolescents. Self-harm is the most important risk factor for suicide, yet the majority of self-harm does not come to the attention of health services. The purpose of this study was to establish the relative incidence of adolescent suicide, hospital-treated self-harm and self-harm in the community....

Background: Conducting research on the work outcomes of first episode psychosis (FEP) samples may extend our understanding of the factors associated with the work outcome of people with schizophrenia and other psychotic illnesses. Objective: To conduct a detailed study of the work outcome of an FEP sample. Methods: Members of a FEP cohort, who...

Early intervention in psychosis is an accepted policy internationally. When 'A Vision for Change', the national blueprint for mental health policy in Ireland, was published in 2007 there was one Irish pilot service for early intervention in psychosis. The National Clinical Mental Health Programme Plan (2011) identified early intervention in psychos...

Objectives: This review examined rates and definitions of disengagement among services for first-episode psychosis (FEP) and identified the most relevant demographic and clinical predictors of disengagement. Methods: A comprehensive search for and review of published studies that reported rates and predictors of disengagement within FEP services...

Background This study investigated the prevalence of DSM-IV Axis 1 mental disorders, deliberate self-harm and suicidal ideation in a sample of Irish adolescents aged 11–13 years. Methods A total of 1131 students was surveyed for general psychopathology using the Strengths and Difficulties Questionnaire. Following this, a representative sample of 2...

Psychotic experiences occur at a much greater prevalence in the population than psychotic disorders. There has been little research to date, however, on genetic risk for this extended psychosis phenotype. We examined whether COMT or BDNF genotypes were associated with psychotic experiences or interacted with childhood trauma in predicting psychotic...

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 i...

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 t...

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...

Background Deficits in working memory are widely reported in schizophrenia and are considered a trait marker for the disorder. Event-related potentials (ERPs) and imaging data suggest that these differences in working memory performance may be due to aberrant functioning in the prefrontal and parietal cortices. Research suggests that many of the sa...