bluuebunny/crossref_metadata_2025 huggingface dataset:
Bipolar affective disorder as the initial manifestation of multiple sclerosis
Authors: Vohra Adarsh , Leeming Caroline
Published: March 2016

The association between bipolar affective disorder and multiple sclerosis continues to be poorly understood in view of the limited knowledge and research in this field. Here we present the case of a 43 year old female with bipolar affective disorder who later developed multiple sclerosis. The relationship between the two disorders is discussed in the light of relevant and pertinent literature. It is hypothesised that bipolar affective disorder may be the presenting manifestation of multiple sclerosis and should be considered as a differential diagnosis in patients of bipolar affective disorder with neurological symptoms.
Combined antipsychotic use in a community rehabilitation psychiatric service
Authors: Apantaku-Olajide Tunde , Khattak Abid , Whitty Peter
Published: March 2016

Objectives:

Despite the clinical guidelines regarding the use of combined antipsychotics and the limited evidence for its benefits, use remains high in psychiatric practice. The aim of this study was to examine prescribing practices and investigate reasons for initiating and continuing combined antipsychotics in stable psychiatric illnesses.

Method:

A cross-sectional case record survey of antipsychotic prescribing practices in a community psychiatric rehabilitation service. A total sample (n = 75) of patients with chronic and enduring psychiatric illnesses was studied. The age, gender, diagnosis and prescribed antipsychotics were examined. The proportional prevalence and documented reasons for combined antipsychotic prescribing were analysed.

Results:

Seventy-three of the 75 patients were prescribed antipsychotic mediations. Of these, 44 (60%) received a combination of two or more antipsychotics. The most common reason for combined prescribing was a switch of antipsychotic (n = 18; 41%). No reason was documented in 19 cases (43%).

Conclusions:

In this study, slow cross-tapering or incomplete switch process of antipsychotics contributed to the prolonged period of combined antipsychotics treatment. Adequate documentation regarding indication and review of medications cannot be overemphasized.
Depressive psychosis associated with a cyclo oxygenase 2 inhibitor (meloxicam)
Authors: White Daniel , McCauley MacDara
Published: March 2016

We describe a 60 year old man who developed a fluctuating depressive psychosis associated with meloxicam, a non-steroidal anti-inflammatory drug (NSAID). The psychological symptoms observed were temporally related to the administration of meloxicam and occurred in the presence of signs of meloxicam intolerance, such as skin rash and raised blood pressure. The depressive reaction resolved quickly following cessation of meloxicam, recurring on re-exposure. The psychiatric manifestations of NSAID intolerance are rare, however 40% of cases have a history of mental illness. Data from adverse event reporting systems suggest that the newer NSAIDs (COX-2 inhibitors) may have a higher propensity to cause psychiatric adverse effects and should be used with caution in individuals with a history of mental illness. This data may be provocative given current research in to the use of COX-2 inhibitors in augmenting neuroleptic treatment in schizophrenia.
The use of inpatient services in patients with borderline personality disorder
Authors: O'Neill Sinead , Curran Ruth , Canning Catherine , Daly Oscar
Published: March 2016

Objectives: To examine why five patients with borderline personality disorder were contributing to a high bed occupancy and high staff turnover on a general adult psychiatry inpatient unit.

Method: A retrospective audit looking at these individuals' service pattern use for the two-year period between 2001–2003 was undertaken. A new admission policy was then introduced. The policy was that admissions were agreed, where possible, at consultant level and, if deemed unavoidable, were time limited. The audit cycle was repeated for the next two year period, 2003–2005 and a third audit cycle was then performed for the period 2005–2007.

Results: Following the new admission policy, there was a 95% reduction in bed days for this group. Untoward incidents by these individuals reduced by 93% and attendance at Accident and Emergency was also significantly reduced.

Conclusions: By limiting the frequency and length of admissions there was, unsurprisingly, a reduction in adverse incidents which lead to significant problems for patients and staff alike.
Catatonia – case report and review
Authors: O'Brien Finian M , Moroney Joan , Lyons Declan , Murphy Kieran C
Published: March 2016

Catatonia is a neuro-psychiatric disorder that can occur in medical, psychiatric and drug-induced conditions but is often unrecognised. A 64 year-old woman was admitted to hospital for assessment of a significant deterioration in her ability to communicate and function normally so that she had become completely dependent on others for all activities of daily living for nearly three years. Outpatient medical and psychiatric assessments failed to clarify diagnosis. On admission to a general hospital, the neurology team initially believed she had a Parkinson's-like syndrome but after further investigation and comprehensive multidisciplinary assessment, including neuro-psychiatric review, she was diagnosed with catatonia. She was subsequently admitted to a psychiatric hospital where she received electro-convulsive therapy and changes to her psychotropic medication regimen. She responded well to treatment and within a short period of time was able to function independently again.
Cardiac rehabilitation: the role of psychological intervention
Authors: McGee Hannah
Published: March 2016

A coronary event has major psychological, as well as physical, consequences. The recent British Cardiac Society's Working Party Report on Cardiac Rehabilitation acknowledges the importance of comprehensive rehabilitation programmes incorporating a psychological input. Psychological intervention as part of cardiac rehabilitation serves two purposes: to maximise psychosocial recovery, including return to customary activities such as work and sexual relationships, and to facilitate the secondary prevention of coronary heart disease. The latter involves providing behavioural change strategies for a range of lifestyle factors from stress identification and management, through dietary, smoking and physical activity change, to increasing adherence to medication regimes.

Psychological interventions have proven successful in decreasing general morbidity in the year after coronary events and in reducing reinfarction-related mortality. Little is understood about the mechanisms by which psychological interventions may operate. However, a recent seminal study of intensive lifestyle modification in cardiac patients has demonstrated that it is possible to achieve regression of atherosclerosis (although the authors themselves caution that their intensive methods are unlikely to be applicable in most patient settings). More general discussion of the relationship between psychological factors and coronary disease is available. With regard to enhancement of psychosocial recovery, early work documented positive effects of exercise-only programmes on psychosocial functioning.
The treatment of child sex abusers in England
Authors: Schofield Anne
Published: March 2016

A Council of Europe Fellowship was used to visit several centres in England managing and treating child sex abusers in a community setting. Aspects of the services reviewed included organisation, training of staff, assessment of abusers, methods of treatment and resources and facilities available. The application of the English experience to the establishment of treatment programmes in Ireland is discussed.
An analysis of general practice referral behaviour to psychiatric out-patient clinics
Authors: Carey Teresa , Owens John , Mulligan Pauline , Moran Damien
Published: March 2016

Objective: The objective of this study was to analyse general practice referrals to psychiatric out-patient clinics and their relation to practice and patient variables.

Method: Retrospective analysis of new episode attendances at out-patient services over a three year period was undertaken. Referring practices were examined for referral rates, single or group practice and the presence of Vocational/Psychiatric training within the practice.

Results: Referral rates were similar to national rates, but were lower than other jurisdictions. There was a tendency for group practices to have lower referral rates.

Conclusions: There was considerable difference between practices in referral rates. These differences were significantly related to GP vocational training.
Attendance at a psychiatric day centre
Authors: Lynch Gerry , McKee Margaret , Brennan Daniel M
Published: March 2016

Objective: To examine the service utilisation of a newly opened psychiatric day centre. We wished to determine if different diagnostic groups had different perspectives of the day centre, and to see if the drop-out rate differed among clients with neurotic or psychotic disorders.

Method: Demographic and diagnostic data was gathered for all clients referred in the first year of operation of the day centre. Those who defaulted from attendance were visited at home and asked to detail reasons for non-attendance. Those who continued to attend 16 months after the centre opened completed a satisfaction survey.

Results: The drop-out rate was high for both clients with neurotic and psychotic disorders. Clients who continued to attend were very positive about the day centre. Both client groups saw the benefits of attendance in social rather than therapeutic terms.

Conclusions: Consumer opinion may have a valuable part to play in overall measure,measurement of service quality, particularly if it includes the opinion of those who no longer use that service.
Prognosis of depression in the elderly
Authors: Freyne Aideen , Wrigley Margo
Published: March 2016

Objective: To ascertain the outcome of depression and factors associated with outcome over a minimum followup period of 12 months in patients referred to an Old Age Psychiatry Service.

Method: A retrospective study was performed. All depressed patients assessed by the service between January 1989 and December 1990 were followed up. This included patients seen on domiciliary and consultationliaison visits. Follow up data included information on physical, psychological, cognitive and social parameters using standardised scales where appropriate. Outcome of depression was assessed using a six point scale to enable comparison with other studies.

Results: 86 patients with a primary diagnosis of depression were seen in 1989 and 1990. At follow up, 37% were dead. 50% of patients alive at follow up were well and 7% were demented. Patients seen on domiciliary visits had the best outcome, and those with physical illness or cognitive impairment at presentation the worst outcome.

Conclusion: The association between physical status and outcome highlights the need for close monitoring of both physical and mental status of depressed elderly patients.
Abuse of the elderly with dementia
Authors: Cooney Colm , Wrigley Margo
Published: March 2016

It is 20 years since the first references to elder abuse appeared in the medical literature. Since then there h as been a growing realisation that although most elderly people are cherished by their families a substantial minority are at risk of abuse. Prevalence studies in different countries have suggested that approximately 5% of those over 65 may be subjected to various forms of abuse including physical, verbal, financial abuse and neglect.
Platelet serotonin aggregation in depression
Authors: Keely Helen , Ring Mary , Dunne Anne MM , Kelleher Michael J , Corkery Finbarr
Published: March 2016

Serotonin aggregation is a measure of function of platelet 5-HT2 receptors. The test has been proposed as a valid peripheral model of central 5-HT2 receptor function. Receptors of this subtype are implicated in theories of the aetiology of depressive states.

This pilot study proposes a normal range for the test for both males and females. Untreated depressed subjects had results which grouped at the lower end of the range. The test proved reproducible with a correlation coefficient of r = 0.939 with an interval of at least six weeks between sampling. A small number of successfully treated patients were retested with no empirical difference in their results, which are included in the reproducibility studies.

Our provisional results indicate the reliability of serotonin aggregation scores for an individual. The difference in scores noted in depressed subjects is more likely to be a trait rather than a state marker.
A study of psychiatric inpatient suicides
Authors: Coakley Gráinne M , Carey Teresa G , Owens John M
Published: March 2016

Objective: The aim of this paper was to elucidate factors associated with inpatient suicide.

Method: A retrospective review of inpatient suicides over a 20 year period in the Cavan/Monaghan mental health service was undertaken. Clinical files, statutory reports and Central Statistics Office returns were studied and information was obtained on demography, diagnosis and circumstances of the event.

Results: Eight patients committed suicide, giving a rate of 0.55/1,000 discharges and 0.39/100,000 population per year. Depressive illness and Schizophrenia were the diagnoses found. Repeated admissions and long duration of illness were noted. Previous suicidal behaviour was common. Four of the patients were considered a suicide risk at some time during the index admission. Underreporting of the suicides and inaccurate registration of institutional location by the Central Statistics Office were found.

Conclusion: More formal clinical procedures in registering suicide risk are recommended. New procedures for investigating inpatient suicides are suggested. Largescale studies at a national level are essential in defining more specific and sensitive risk factors. Procedural changes involving accurate central registration of data are required.
A case of glenophobia
Authors: Briscoe James
Published: March 2016

Doll phobia is a rare phobia that has only been reported twice in the literature, both times in male patients. The following case is the first to be described in a female patient. The characteristics of the dolls that caused most fear in all three cases are compared and the possibility that this indicates a similar genesis of the phobia that could be explored by psychodynamic psychotherapy is discussed. A Hellenic derivation of doll phobia for future use is suggested.
Thomas Willis (1621-1675): First lines in Neuropsychiatry
Authors: Breathnach Caoimhghin
Published: March 2016

Thomas Willis [1621-1675] was not the first to describe the circle of vessels at the base of the brain that bears his name, but it was he who first recognised its functional significance in maintaining cerebral perfusion even after one of its feeding vessels was completely closed. Although Willis made many astute, original clinical observations (concerning myasthenia gravis, paracusis, restless legs syndrome and diabetes mellitus) his reputation suffered because he was an inveterate theorist in an age that frowned on hypotheses. Nonetheless he is now recognised as one of the earliest neuropsychiatrists who attempted to understand and explain mental illness, as he encountered it in his daily practice, in terms of brain dysfunction more than 300 years ago.
The outcome of elderly patients presenting with depressive symptoms
Authors: Lee Heidi , Lawlor Brian A
Published: March 2016

Objective: To examine the treatment of and outcome for elderly patients presenting with depressive symptoms.

Method: 100 consecutive elderly patients presenting to an old age psychiatric service with depressed mood were studied, 51 met DSM-III-R criteria for major depression and 49 met criteria for a range of other diagnoses. Demographic details, psychiatric history and clinical examination including Hamilton Depression Rating Scale, Mini-Mental State Examination and Cumulative Illness Rating Scale scores were recorded at first presentation. Treatment of index episode was recorded and outcome assessed at time of follow up (mean of 19.1 ± 9.1 months later).

Results: 57% of the major depressives and 41% of the other diagnoses had a good outcome. Within the other diagnoses group 30% of the comorbid anxiety/depression patients and none of the patients with dysthymia or personality disorder had a good outcome. In the major depression group there was no clear association between outcome and any clinical or demographic measure. Within the other diagnoses group a good outcome was significantly associated with being younger, having had more psychiatric admissions and being less likely to require benzodiazepine treatment (p < 0.05). The two groups received similar treatment except that the other diagnoses group were more likely to have had psychotherapy and the major depressed patients to have had ECT (trend) than the major depressed group.

Conclusions: The outcome for patients with major depression is similar to that found in previous studies. Patients with depressive syndromes associated with dysthymia, personality disorder, or comorbid anxiety/depression respond poorly to conventional treatments of depression.
Resolution of episode of major depressive disorder with emergence of Ganser syndrome symptoms
Authors: Arya Dinesh K
Published: March 2016

A 48 year old housewife, admitted with a diagnosis of major depressive episode suddenly developed Ganser syndrome during the course of her illness. This resulted in spontaneous resolution of symptoms of depression. The resolution of intrapsychic conflict as a result of development of Ganser syndrome which led to sudden remission of major depressive episode is discussed.
Specialist psychiatric training in Britain: An Irish graduate's perspective
Authors: Lucey James V
Published: March 2016

Many Irish graduates chose to pursue specialist psychiatric training in Britain. Regulations governing UK specialist training are currently changing in response to European Union (EU) directives. Furthermore, over the past five years the UK national health service has undergone significant reforms. This paper reviews the current status of British postgraduate training and examines the options for Irish doctors who take this route to a career in psychiatry.
Residency training in psychiatry in the USA: an Irish graduate's perspective
Authors: Kirrane Richelle , Serby Michael
Published: March 2016

Residency training in psychiatry in America is an option which has been little explored by Irish psychiatric trainees, although one which is readily available to them. This article attempts to illustrate this option by providing a brief outline of residency training, and by comparing this with psychiatric training in Ireland or the UK.
Chaos theory, psychiatry, and a quiet revolution
Authors: Tobin John
Published: March 2016

What is probably one of the most exciting potential advances in psychiatry is occurring slowly, possibly too slowly and has gone unnoticed by many. I am talking about ‘Chaos theory’, which is a mathematical concept that has influenced the study of such diverse subjects as the weather, evolution and the electroencephalogram. Is it our lack of mathematical training that makes us so fearful? This may be so, but we can still understand chaos theory without having to learn large mathematical formulae.

Chaos theory is about dynamic non-linear systems that are orderly at first, but may become completely disorganised over time. That is initial conditions that are alike in the beginning, may have markedly different outcomes over time. An analogy commonly drawn from weather studies is the butterfly effect. This draws on the premise of initial conditions which is a butterfly fluttering its wings in Tokyo can lead over time and distance to a storm for example over New York. In other words a small perturbation in a non-linear system can lead to great variations in outcome. The chaos theory is about how phenomena can vary between different kinds of states around what is called a ‘strange attractor’ and obtain from this a semblance of order out of what initially can be perceived as disorder.

In this way chaos differs from random behaviour and causal systems. Eventual outcome in a random system is not determined by initial conditions. The eventual outcome in a causal system has a linear relationship with its initial conditions. In other words a small change in initial conditions will lead to a small change in the eventual outcome. But in Chaos theory a small change in the initial conditions can lead to major changes in the eventual outcome. These changes become exponential over time.

The original example of a chaotic system was developed by Lorenz. In his early work on weather systems he found using computer simulations that started with similar, but slightly different initial data, orbits would stay close to each other for a while but would eventually diverged in a manner that turned out to be exponential over time. His model was deterministic, that is the orbits were unique in the sense that there was only one orbit passing through a given point of the space in which the orbit lay. The three variables he was measuring were convective air circulation in relation to vertical and horizontal temperature variations.
Lack of gender differences in familial schizophrenia
Authors: Murphy Bernadette M , Burke John G , Bray Joseph C , Walsh Dermot , Kendler Kenneth S
Published: March 2016

Objective:Gender appears to have a significant impact on the prevalence, age at onset, symptoms and outcome of schizophrenia. This study examines gender effects in a population of familial schizophrenic patients in Ireland.

Method:Families with two or more siblings suffering from schizophrenia, as defined by DSM-III-R were ascertained in Ireland. The final sample comprised 169 siblings from 80 families. Siblings were interviewed using the Structured Clinical Interview for DSM-III-R (SCID), the Scale for the Assessment of Negative Symptoms (SANS) and the Strauss-Carpenter Levels of Functioning Scale. The difference between males and females for various clinical features were calculated.

Result:There was a marked excess of affected males (65% male and 35% female). When the excess of male subjects was taken into account there was no significant excess of same-sex as compared to opposite-sex pairs. There were no significant difference between males and females for age at onset, age at first admission, symptoms or level of outcome.

Conclusion:The excess of males and the lack of gender differences for clinical features found in this study may, in part, be due to the narrow diagnostic criteria used. Alternatively, at least some of these findings may be specific to this Irish sample. Further research is a need to see if these findings can be replicated in other countries.
Compulsive water drinking status reviewed after four years
Authors: Cooney John A , Zibin Terry O , Garbharran Hari N
Published: March 2016

Objectives: 1) To ascertain the stability of a diagnosis of compulsive water drinking (CWD) among psychiatric rehabilitation inpatients after a period of four years. 2) To ascertain the discharge status of CWD inpatients in comparison with matched control inpatients after a period of four years.

Method: A follow-up study was performed. Urine specific gravity testing was used to determine CWD status among psychiatric rehabilitation inpatients. Originally, 21 CWD subjects were identified, and 21 age and sex matched control subjects were selected from the non-CWD rehabilitation inpatients. Four years later those CWD and control subjects successfully traced (18 and 15 respectively) were retested for CWD. In addition each subject's living situation (inpatient or community resident) was recorded. Chi-square, Odds Ratio, and Fisher's Exact Test were used as tests of statistical significance.

Results: While the original CWD status was associated with the follow-up CWD status using Chi-square (p < 0.05), there was no statistical association using Odds Ratio (95% CI was 0.95 to 71.6). Half of the 18 original CWD subjects retested negative for CWD. Two of the 15 control subjects retested positive for CWD. Original CWD status was not associated with subsequent living situation, however all seven community dwelling subjects (four original CWD, three original controls) that were successfully traced were negative for CWD.

Conclusions: CWD status may not be as stable as implied in the literature.
False memory syndrome – balancing the evidence for and against
Authors: Critchlow Stephen
Published: March 2016

The false memory syndrome has been the subject of recent intense debate. Can false memories of child sexual abuse be engendered in the minds of susceptible individuals by well meaning therapists? This paper examines the evidence for false memories. Memory in childhood and adults is discussed, and the different processes involved in traumatic memory are emphasised. Evidence for amnesia following sexual abuse with subsequent recall is presented.

It is important to weigh carefullythe evidence both for and against the false memory syndrome. Good evidence for false memories exists, but conversely amnesia and subsequent recall of sexual abuse undoubtedly occur. The principle of primum non nocere is particularly important in guiding therapeutic endeavours.
Early onset dementia – a catchment area study of prevalence and clinical characteristics
Authors: Freyne Aideen , Kidd Nick , Lawlor Brian A
Published: March 2016

Objectives: To identify the number of cases, and hence the prevalence of, early onset dementia within a defined catchment area in Dublin. To identify the associated clinical characteristics of those identified, and to measure service use and carer burden.

Method: A comprehensive case finding study was carried out, and all those identified were contacted and sufferers and carers were interviewed using both standardised and semi-structured questionnaires.

Results: Twelve cases were identified, yielding a prevalence rate of 45/100,000 in the 45-64 year age group. Sufferers exhibited a high level of cognitive impairment and associated psychiatric and behavioural symptoms, and carers exhibited a high level of stress, especially those still actively caring. Service provision for this group was patchy and did not tally with their level of dependency.

Conclusions: Recommendations are made for appropriate provision of services for dementia sufferers, regardless of age.
A five year follow-up study of dementia in persons with Down's syndrome: early symptoms and patterns of deterioration
Authors: Cosgrave Mary P , Tyrrell Janette , McCarron Mary , Gill Michael , Lawlor Brian A
Published: March 2016

Objectives: To investigate the development of dementia over a five year follow up period in a population of females with Down's syndrome; to examine age at onset and duration of dementia in the population; to document the clinical features of dementia and to highlight scores on functional and cognitive rating scales at diagnosis of dementia and at the onset of complete dependency.

Method: A five year follow-up study of 80 female subjects on prevalence of dementia, early clinical features of dementia and patterns of scoring on rating scales at diagnosis and end-stage dementia was completed. Results: Over the five year study period the number of subjects diagnosed with dementia rose from seven (8.75%) to 35 (43.75%). Age related prevalence figures showed that dementia was more common with increasing age. The earliest recognisable symptoms of dementia were memory loss, spatial disorientation and loss of independence especially in the area of personal hygiene. These findings were confirmed by the rating scales used in the study.

Conclusions: The earliest recognisable clinical features of dementia include memory loss and increased dependency. The results of this study should facilitate earlier diagnosis of dementia in DS.
I. A profile of attenders at psychiatric outpatient clinics in Ireland's Eastern Health Board Region
Authors: O'Neill Winifred , O'Boyle James H , Harford Violet , Cooper Conrad , Igoe Teresa , Farrell Martin , McKay Paula
Published: March 2016

Objectives: The aim of this study was to determine the profile of attenders at psychiatric outpatient clinics in community health centres in Dublin.

Method: A chart review was undertaken retrospectively on attenders at two clinics in different socioeconomic areas. Demographic data and information on services was recorded. Psychiatric outpatient clinic functioning in a community setting was observed during the period of the study.

Results: The findings of this study suggest that attenders at psychiatric OPD clinics are more likely to be long-term, in the 40-50 year age group, female, unemployed and eligible for free medical care within the General Medical Services (GMS). Mood (affective) disorders was the largest diagnostic category. There were financial barriers to patient discharge to primary care and shared care with general practitioners.

Conclusions: Opportunitie s have been identified to improve communication and optimise patient flow through the psychiatric OPD system. Such improvements in clinic function would be likely to lead to enhanced health gain for attenders.
Health of the Nation Outcome Scales (HoNOS): use in an Irish psychiatric outpatient population
Authors: Browne Stephen , Doran Michael , McGauran Sheila
Published: March 2016

Objectives: To evaluate the clinical utility and validity of the Health of the Nation Outcome Scales (HoNOS) in an Irish catchment area psychiatric service.

Method: One hundred consecutive outpatients were assessed using the HoNO S and Global Assessment of Functioning (GAF) scales.

Results: It was feasible to administer HoNOS in day-to-day clinical practice. There was a statistically significant correlation between the HoNO S and GAF scores. Attenders at the outpatient department had significantly lower HoNOS scores compared to individuals assessed on domiciliary visits or at the day hospital. Individuals with schizophrenia had significantly higher HoNO S scores compared to affective disordered patients. However, this difference was confined to the Social subscale of HoNOS.

Conclusions: Although these findings indicate that HoNOS has significant convergent and criterion validity as a measure of psychiatric morbidity, its widespread use in day-to-day clinical practice may be premature.
A survey of the self-rated quality of life of individuals with schizophrenia in community residential settings
Authors: Flanagan Siobhan , Doyle Mairead , Browne Stephen , Larkin Conall , O'Callaghan Eadbhard
Published: March 2016

Objectives: To evaluate the self-rated or subjective quality of life of individuals with schizophrenia in residential care settings.

Method: Forty individuals who fulfilled DSM-IV criteria for schizophrenia were interviewed using the Lancashire Quality of Life Profile.

Results: Fifty-two per cent of the sample reported their global subjective quality of life to be satisfactory. Global subjective quality of life was rated lower than the majority of life domains evaluated. The areas of least satisfaction included finances and work. However, the majority of patients were satisfied with their living situation, safety, health, religion, leisure, social and family relations. There was some evidence of a quality of life gradient across these residential settings.

Conclusions: Although these patients were satisfied with the majority of life domains assessed, these data need to be interpreted cautiously given the limitations of the study design and the method used to evaluate quality of life.
Assessment of need in patients attending an inner city psychiatric service
Authors: Gannon Miriam , Ryan Martina , Kinsella Anthony
Published: March 2016

Objectives: The aims of this study were to identify the social and clinical needs of patients attending an inner city psychiatric service, to examine the relationship between need and various demographic and social parameters, and to demonstrate the usefulness of the Camberwell Assessment of Need (CAN) in an Irish population.

Methods: A random sample of patients was selected from a census of patients attending the Mater Hospital (Dublin) sector psychiatric service on March 1, 1997 for inclusion in the study. Needs were assessed using the Camberwell Assessment of Need.

Results: Fifty-seven patients agreed to participate in the study. The mean number of needs identified by patients was 2.14 (+/− 2.09) and by staff 1.92 (+/−1.18). There was a high level of correlation between staff and patients. The areas where patients most frequently expressed a need were ‘psychological distress’, ‘company’, ‘physical health’, ‘information’ and ‘looking after the home’. Eighteen patients (32%) identified needs that were not being met.

Conclusions: This study confirms the usefulness of the Camberwell Assessment of Need in the identification of clinical and social needs in psychiatric populations and demonstrates its usefulness in an Irish population.
A descriptive study of juvenile delinquents
Authors: Barnes Jim , O'Gorman Noel
Published: March 2016

Objective:The aim of this study was to describe the social, physical, intellectual and psychological characteristics of juvenile delinquents in Dublin.

Method:One hundred consecutive admissions to the St. Michael's Assessment Centre between March 1,1989 and May 31, 1991 were studied. Information was gathered on a wide range of personal, family and social aspects of the delinquents' lives, together with data on their physical, intellectual and psychological profiles.

Results:The majority of subjects came from deprived social and economic backgrounds. 62% of the delinquents were below the 50th percentile for height while 21% were classified as mentally handicapped. The most common psychiatric diagnoses were socialised conduct disorder and mixed disorder of conduct and emotions. Depressive symptoms were endorsed by 12% of the boys and this subgroup tended to engage in more serious offences.

Conclusions:This retrospective study demonstrates the high degree of social, physical, intellectual and psychological disadvantage experienced by Dublin juvenile delinquents and underscores the need for further prospective studies in this poorly understood section of our society.
Commentary on: “Training in psychodynamic psychotherapy: the psychiatric trainee's perspective”
Authors: Clare Anthony W
Published: March 2016

The concerns expressed by Dr. Trigwell and his colleagues are not new. They have been expressed by many critics of psychoanalysis and psychodynamic psychotherapy including within the past decade Frederick Crews and Robert Wilcocks. What gives them a particular relevance and urgency is the fact that they have been articulated by young psychiatrists in training, individuals exposed to the actual practical application of psychoanalytic theory as distinct from theoretical explorations of it. The depressing thing is the reaction of one of the course supervisors. It may well serve only to reinforce their critical view.

The criticisms can be summarised as follows. First, the theories of Freud and his successors were taught on this course at any rate as scientifically established facts rather than as theories or constructs concerning human behaviour, helpful insights in certain instances but not always relevant. These theories and related interpretations were formulated in a way that made it impossible to refute them. They tended to be used in a way that suggested that they explain everything from the most trivial and reflex of thoughts and responses to the most complex and profound.

These criticisms, it might be said, relate to the actual content of psychoanalysis and psychodynamic psychotherapy, to what is being taught. Raymond Tallis has put the same general criticism with somewhat more force, observing that the manner in which psychoanalytic conclusions are drawn from clinical case histories “is reminiscent of how a first year medical student or a hypochondriac, using a few observations to light a gunpowder trail of inference primed with his own preconceptions, might arrive at a wrong diagnosis”.
Wernicke-Korsakoff syndrome following self-induced starvation
Authors: Arya Dinesh K
Published: March 2016

A non-alcoholic patient is reported who as a result of self-induced starvation was found to have nystagmus, gait ataxia and severe deficits in recent and remote memory and new learning, with intact immediate recall, abstraction and judgement capabilities. This pattern of cognitive deficit with nystagmus and ataxia suggests the diagnosis of Wernicke-Korsakoff syndrome.
Screening for depression in hospitalised elderly medical patients
Authors: Farragher Barbara , Wrigley Margo , Donohoe Orla , Duggan Joseph
Published: March 2016

Objective: The aim of this study was to screen a group of medically ill elderly hospitalised patients for depression and to facilitate this using a new screening questionnaire called the Evans Liverpool Depression Rating Scale (ELDRS).

Method: The questionnaire was administered by a geriatric registrar to a consecutive series of 37 acutely ill elderly medical inpatients admitted to an acute hospital ward. They were subsequently interviewed by a member of the psychiatry of old age team.

Results: Seven of the 37 acutely ill elderly patients admitted to hospital were found to be suffering from a major depressive illness according to DSMIIIR criteria. Of the patients screened, two were already on antidepressant medication. Five of the depressed patients were identified by using the ELDRS. All of the depressed group were judged to require antidepressant medication and two were referred to a psychiatry of old age day hospital.

Conclusions: Our results suggest that there is a raised prevalence of depressive illness in elderly acutely ill medical patients which remains undetected. Use of a screening questionnaire such as the ELDRS would increase the likelihood of its identification in this group.
Clozapine induced encephalopathy
Authors: Hennessy Michael J , Pugh Catrin N , Wiles Charles M , Watkins Sarah E
Published: March 2016

Clozapine has become a widely used drug in therapyresistant schizophrenia and, increasingly, in the levodopa-induced dyskinesias and the psychoses of chronic Parkinson's disease. We report the case of a 43 year old male patient who developed a reversible encephalopathy associated with clozapine therapy.
Visual alcoholic hallucinosis
Authors: Sloan Darina , O'Boyle James
Published: March 2016

A case of alcoholic hallucinosis with vivid visual hallucinations is presented. The relevant literature is briefly reviewed with reference to the aetiology of this condition.
An economic evaluation of inpatient treatment versus day hospital care for psychiatric patients
Authors: O'Shea Eamon , Hughes Jenny , Fitzpatrick Lourde , Dunne Elizabeth , O'Sullivan Mary , Cole Margaret
Published: March 2016

Objectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.

Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 -February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.

Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.

Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.
Criminal responsibility and mental illness in Ireland 1850-1995: fitness to plead
Authors: Gibbons Pat , Mulryan Niamh , McAleer Angela , O'Connor Art
Published: March 2016

Objectives: To describe forensic and clinical characteristics of unfit to plead defendants in Ireland between 1850 and 1995 as well as outcome in terms of length of stay in custody and ultimate disposal of cases. These data are compared with studies from the US and the UK. The White Paper on Mental Health (1995) highlights the need for significant change in the management of mentally ill defendants who come before the courts. The current criteria for the assessment of fitness to plead date from 1836. There has been little previous research on the use of fitness to plead procedures in Ireland which might guide future law reform.

Method: This is a retrospective study of demographic, forensic and clinical data on an almost complete sample of 488 unfit to plead patients admitted to the Central Mental Hospital between 1850 and 1995. A standardised profile was completed on each subject with data drawn from hospital records and entered onto a database for analysis.

Results: The use of the fitness to plead procedures peaked in the period 1910-20, and has fallen into substantial decline since then. Defendants were usually male, with a mean age of 37 years who had been charged with a violent crime. Three quarters of defendants were psychotic on admission. The mean length of detention was 14.3 years and only 4% were ultimately returned for trial.

Conclusions: The decline in the number of fitness to plead findings is probably related to the reluctance of defendants to use the procedure due to the resulting prolonged period of detention. The introduction of a formal judicial review procedure to reassess the appropriateness of detention is urgently required to protect the civil liberties of those found to be unfit to plead.
Patterns of service use among people with learning disabilities discharged from long-stay hospital care in Northern Ireland
Authors: McGilloway Sinéad , Donnelly Michael
Published: March 2016

Objectives: Continuing deinstitutionalisation has led to growing concern about the availability and accessibility of services for people with learning disabilities transferring to community living. This study was undertaken in order to assess the configuration of services in terms of availability and uptake for people with learning disabilities who have left long-stay hospital care and to identify gaps or barriers to service provision within the unique integrated health and social services structure in Northern Ireland.

Method: The ‘keyworkers’ of 195 people – most of whom were aged 40-59 years with a diagnosis of moderate intellectual impairment – were interviewed by a researcher one year after discharge using the Service Interview.

Results: While a wide range of generic and specialist services was available, ‘packages’ of care consisted largely of public sector services (eg. GPs, chiropodists and social workers) and relied, to some extent, on the type of community accommodation. Although services appeared well co-ordinated in terms of care reviews and keyworker arrangements, 40% of people required more one-to-one support particularly in areas related to integration. However, services were perceived by care staff to be satisfactory

Conclusions: The development of community care has been slower in Northern Ireland than elsewhere and a large proportion of resources remain tied up in hospital care. However, existing community-based services appear to be addressing individual needs. Some former patients, though, may have been subject to transinstitutionalisation in the sense that their choice of accommodation was restricted mainly to large private sector homes and work and daytime opportunities were insufficient to facilitate integration. Service planners and providers need to give further consideration to the likely effects of different forms of rehabilitation, reprovision and resettlement and to be aware that the pattern of service provision is likely to be different for the more dependent cohorts of people who leave hospital in the future.
Outcome studies in schizophrenia
Authors: Browne Stephen , Larkin Conall , O'Callaghan Eadbhard
Published: March 2016

Objectives:To outline the limitations of traditional studies of outcome in schizophrenia and to review the findings arising from ‘first episode’ psychosis studies.

Method:An extensive literature search was performed and relevant papers were examined and analysed.

Results:Current knowledge regarding outcome predictors in schizophrenia has primarily been derived from a series of ‘consecutive admission’ and ‘long-term follow-back’ studies. However, methodological considerations may limit the generalisability of these studies' findings. The prospective evaluation of first episode cohorts has advanced our knowledge regarding the relative importance of premorbid and intercurrent factors in determining outcome in schizophrenia.

Conclusions:To date, the ‘first episode’ strategy has highlighted some potentially clinically modifiable outcome predictors. These findings may open the way for targeted introduction of measures aimed at preventing poor outcomes in schizophrenia.
Lead encephalopathy secondary to petrol inhalation
Authors: Morgan Maria , Owens John , Pillay Prega
Published: March 2016

Lead encephalopathy is a relatively rare medical condition. It can present with multiple seizures, delirium, blindness, aphasia and dementia. Usually it is due to environmental exposure. This paper describes a case of delayed diagnosis of lead encephalopathy secondary to petrol sniffing which responded to chelating agents therapy. A high index of suspicion must be maintained to diagnose this treatable cause of encephalopathy.
Sleep paralysis and attempted suicide: a case report
Authors: Hosty Gary , Abbott Joanna
Published: March 2016

A case of suicidal behaviour precipitated by sleep paralysis is described. The condition and related phenomena are briefly considered.
Completed suicide: an update for the general psychiatrist
Authors: O'Shea Brian , Stokes Marjorie , Falvey Jane
Published: March 2016

Objectives: To review the most recent information on completed suicide for the general adult psychiatrist.

Methods: Literature review.

Results: Suicide is the result of a complex interaction of multiple variables. Prediction is highly dependent on clinical evaluation. Predictive factors identify groups better than individuals. Prevention has both clinical and political implications.

Conclusions: Reduced access to lethal methods (historically, from barbiturates to modified vehicle exhaust systems and paracetamol), attention to social factors (such as alcohol availability and employment levels) and clinical vigilance, coupled with adequate treatment of psychiatric disorders and close follow-up, should help to reduce suicide rates. Wider cultural issues (eg. religion) are poorly understood and require further research.