Publications by authors named "Patrick Devitt"

7 Publications

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Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic.

Open Heart 2021 08;8(2)

Department of Cardiology, Saint James's Hospital, Dublin, Ireland.

Introduction: The COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.

Methods: Patients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.

Results: A total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).

Conclusion: A significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.
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http://dx.doi.org/10.1136/openhrt-2021-001716DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8338315PMC
August 2021

COVID-19-associated myocarditis presenting as new-onset heart failure and atrial fibrillation.

BMJ Case Rep 2021 Jul 12;14(7). Epub 2021 Jul 12.

Cardiology, St James's Hospital, Dublin, Ireland.

A 58-year-old man presented to the emergency department with recent-onset palpitations and progressive exertional dyspnoea. ECG demonstrated new-onset atrial fibrillation. Transthoracic echocardiogram showed global impairment in left ventricular systolic function with left ventricular ejection fraction of 20%. Cardiac MRI (CMRI) demonstrated generalised severe myocarditis. A SARS-CoV-2 PCR was positive for SARS-CoV-2 RNA. As such, we diagnosed our patient with COVID-19-associated myocarditis based on CMRI appearances and positive SARS-CoV-2 swab. This case highlights that COVID-19-associated myocarditis can present as new atrial fibrillation and heart failure without the classic COVID-19-associated symptoms.
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http://dx.doi.org/10.1136/bcr-2021-244027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276282PMC
July 2021

COVID-19-associated myocarditis presenting as new-onset heart failure and atrial fibrillation.

BMJ Case Rep 2021 Jul 12;14(7). Epub 2021 Jul 12.

Cardiology, St James's Hospital, Dublin, Ireland.

A 58-year-old man presented to the emergency department with recent-onset palpitations and progressive exertional dyspnoea. ECG demonstrated new-onset atrial fibrillation. Transthoracic echocardiogram showed global impairment in left ventricular systolic function with left ventricular ejection fraction of 20%. Cardiac MRI (CMRI) demonstrated generalised severe myocarditis. A SARS-CoV-2 PCR was positive for SARS-CoV-2 RNA. As such, we diagnosed our patient with COVID-19-associated myocarditis based on CMRI appearances and positive SARS-CoV-2 swab. This case highlights that COVID-19-associated myocarditis can present as new atrial fibrillation and heart failure without the classic COVID-19-associated symptoms.
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http://dx.doi.org/10.1136/bcr-2021-244027DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276282PMC
July 2021

Quality of Life and Functioning One Year After Experiencing Accumulated Coercive Events During Psychiatric Admission.

Psychiatr Serv 2015 Aug 15;66(8):883-7. Epub 2015 Apr 15.

Mr. Shannon, Dr. Feeney, and Prof. Murphy are with the Department of Psychiatry, and Mr. Madigan is with the Institute of Leadership, Royal College of Surgeons in Ireland, Dublin (e-mail: ). Mr. Shannon is also with the Mental Health Commission, Dublin, where Dr. Devitt is affiliated. Dr. Feeney and Mr. Madigan are also with Cluain Mhuire Mental Health Service, where Dr. Roche and Dr. Dolan are affiliated. Dr. Renwick is with the Department of Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, London. Dr. O'Donoghue is with Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia. A poster reporting results of this study was presented at the European Congress on Violence in Clinical Psychiatry, Ghent, Belgium, October 23-26, 2013. An oral presentation of this study was delivered at the European Psychiatric Association's epidemiology and social psychiatry section meeting, Ulm, Germany, May 21-24, 2014.

Objectives: The study aimed to determine the number of accumulated coercive events experienced by patients during inpatient admission, the patients' functioning and quality of life (QOL) one year after discharge, and associations between these variables and patient characteristics and between follow-up outcomes and number of accumulated coercive events.

Methods: A prospective cohort study was undertaken at three community services and an independent hospital in Ireland (N=162). Accumulated coercive events scores were based on patients' legal status, perceived coercion, and exposure to physical restraint, seclusion, or forced medication.

Results: Most (68%) experienced at least one coercive event. Lower functioning predicted more coercive events. At follow-up, the mean subjective QOL score was 63% of the highest possible score, objective QOL improved for 15% of participants, and functioning improved for 70%. Accumulated coercive events did not predict these outcomes.

Conclusions: Coercive events during psychiatric admission appeared unrelated to functioning and QOL at follow-up.
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http://dx.doi.org/10.1176/appi.ps.201400212DOI Listing
August 2015

A study of polypharmacy with second generation antipsychotics in patients with severe and persistent mental illness.

J Psychiatr Pract 2007 Mar;13(2):129-37

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 13210, USA.

Background: There is a paucity of empirical support for polypharmacy with second generation (atypical) antipsychotics (SGAs), especially in understudied populations.

Objective: To investigate the frequency, effectiveness, and safety of this practice in patients with severe and persistent mental illness who are chronically hospitalized.

Methods: A chart review was conducted at a state psychiatric hospital in Syracuse, NY. The study subjects (N=26) were chronically hospitalized individuals with DSM-IV diagnoses of schizophrenia or schizoaffective disorder who were initially prescribed at least one SGA and then received at least one other SGA during the study period. Demographic and clinical data were collected. Baseline and 6-month assessments were compared for statistical significance (p<0.05).

Results: Of the 117 chronically hospitalized inpatients at the study center, 22.2% (N=26) received treatment regimens involving polypharmacy with SGAs. These patients as a group achieved statistically significant reductions on their scores on the Brief Psychiatric Rating Scale (34.2 +/- 11.0 compared with 25.3 +/- 11.8; p=0.016) and the Clinical Global Impressions-Improvement Scale (5.5 +/- 0.6 compared with. 5.0 +/- 0.8; p=0.016) at 6 months. There was a significant decrease in the use of prn medications (7.6 +/- 19.6 compared with 1.6 +/- 2.6; p<0.04). However, the number of patients receiving anticholinergic medications increased from 5 to 8 (p<0.04).

Conclusions: Polypharmacy with SGAs is quite frequent among chronic inpatients with severe and persistent mental illness despite a limited empirical database supporting its use. The results of our pilot study do not demonstrate the effectiveness and safety of this practice. However, methodological shortcomings may have contributed to our failure to detect a true, positive effect. Controlled studies are needed to accurately determine the risks and benefits of SGA polypharmacy.
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http://dx.doi.org/10.1097/01.pra.0000265773.03756.3eDOI Listing
March 2007

Divalproex Sodium Versus Valproic Acid in Hospital Treatment of Psychotic Disorders.

Prim Care Companion J Clin Psychiatry 2000 Apr;2(2):45-48

Department of Psychiatry, SUNY Upstate Medical University at Syracuse, Syracuse; the Department of Psychiatry, Olean Hospital, Olean; and Cattaraugus County Continuing Day Treatment Program, Olean, N.Y.

BACKGROUND: Approximately 50% of pharmacy prescriptions in the United States are filled with generic drugs, which have improved substantially in quality owing to increased governmental regulations. The remaining medicoeconomic question regards whether or not brand-name medications are worth the price. This study evaluates these questions for the brand-name mood stabilizer divalproex sodium and its generic counterpart, valproic acid. METHOD: We conducted a retrospective chart review of all patients who had been taking divalproex and had been switched to valproic acid at 2 local mental health facilities in 1997. Data collected from the inpatient- and day-treatment charts for these 28 patients included dose, duration, side effects, and efficacy (determined using retrospective chart review and the Clinical Global Impressions scale [CGI]) of divalproex sodium compared with valproic acid treatment. RESULTS: t Tests for dependent samples revealed that valproic acid was administered at higher doses than divalproex sodium, but these treatments did not differ in efficacy on the basis of CGI scores. Fisher exact test analyses revealed a trend toward more nausea with valproic acid; also, the combination of nausea, abdominal discomfort, and diarrhea occurred more often in valproic acid-treated patients. There were no differences in the discontinuation of either medicine because of side effects, or in the use of medications to treat gastrointestinal side effects. Efficacy was similar for valproic acid and divalproex sodium. There was no single, significant side effect increase for valproic acid; however, when grouped together, gastrointestinal side effects were statistically significantly increased in valproic acid-treated patients. This appears clinically insignificant because of the lack of difference in drug discontinuation rate or gastrointestinal medication use. CONCLUSION: Given these results and that valproic acid is much less expensive than divalproex sodium, valproic acid appears to be a satisfactory substitution for divalproex sodium in the treatment of frequently hospitalized psychotic patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181204PMC
http://dx.doi.org/10.4088/pcc.v02n0203DOI Listing
April 2000

Gabapentin's effect on agitation in severely and persistently mentally ill patients.

Ann Pharmacother 2002 Jan;36(1):12-6

SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY 13210-2375, USA.

Objective: To study the effects of adjunctive gabapentin on agitation in severely and persistently mentally ill (SPMI) inpatients.

Method: Eleven chronic SPMI inpatients on stable psychotropic medication regimens were evaluated before and after the initiation of adjunctive gabapentin for six months. The following psychometric tests were used: Brief Psychiatric Rating Scale (BPRS), Corrigan Agitated Behavior Scale (CABS), and Clinical Global Impression (CGI)-Severity. Data collection was accomplished via retrospective chart review. An internal reliability check indicated that a chart review BPRS is significantly predictive of one performed face-to-face.

Results: Statistically significant reductions were found at six months for each assessment instrument (p < 0.05, two-tailed). BPRS scores were reduced from 40.6 to 33.2, CABS from 34.4 to 25.0, and CGI-Severity from 5.9 to 5.3. The bulk of the BPRS reduction was accounted for by several subscores exclusive of those assessing affective/anxious symptomatology. Adverse effects were minimal. Two patients were discharged 12 and 17 months after implementation of gabapentin.

Conclusions: Adjunctive gabapentin appears to be associated with a reduction in agitation in chronically hospitalized SPMI patients. Controlled, prospective trials are needed before any definitive conclusion can be drawn regarding the role of gabapentin in the treatment of this group of patients.
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http://dx.doi.org/10.1345/aph.10352DOI Listing
January 2002
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