bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors influencing general practitioner referral to a child psychiatric service
Authors: Chithiramohan Ramalingam N , Ballard Clive G , Baxter Mark A , Jones Linda , Handy Sumithra , McGibben Lawrence , Sheikh Anwar , Silveira Raza
Published: March 2016

Objective: To investigate factors influencing general practitioner referrals of children with psychiatric disorders to specialist services. Method: One hundred and sixty seven general practitioners were asked to complete a detailed questionnaire concerning their referral practices. Results: Emotional disorder, conduct disorder, drug abuse and habit disorder were the problems most likely to be referred to the child psychiatric clinic. Parental concern and the severity of the child's illness were considered to be more important than social circumstances in determining referral to specialist services. Conclusions: Many general practitioners indicated that they would have referred children with psychiatric disorders to specialist services other than child psychiatry. Proactive liaison work is needed to increase the awareness and confidence of general practitioners in child psychiatric services.
Cognitive formulation for morbid jealousy (Othello syndrome)
Authors: Arya Dinesh K
Published: March 2016

A patient suffering from psychotic morbid jealousy is reported and a formulation to understand the psychopathology cognitively is presented demonstrating that cognitive formulation can be utilized for understanding of psychotic morbid jealousy patients as well.
Father-son incest: case report and review of the literature
Authors: Murphy Kieran C , Shelley Rory K
Published: March 2016

A case report of father-son incest is described. A review of the literature suggests that father-son incest may be significantly under-reported. We suggest that this may be because it is seldom sought after and even less readily recognised. The possibility of the male incest victim should be considered in males who present with depression, severe anxiety, low self-esteem and difficulties with sexual orientation.
The Fregoli syndrome and cannabis delusional disorder
Authors: Eva Francis J , Perry David
Published: March 2016

A case of the Fregoli syndrome in a patient meeting the DSM-III-R criteria for Cannabis Delusional Disorder is presented. It appears to the authors, after reviewing the literature on the subject, that the delusion ascribed to the Fregoli syndrome, which occurs mainly in Schizophrenia, is being noted in a slowly widening group of psychotic disorders, of which Cannabis Delusional Disorder is the latest.
Panic and agoraphobia associated with a cerebral arteriovenous malformation
Authors: Kelly Christopher B , Cooper Stephen J
Published: March 2016

A patient with epilepsy developed panic and agoraphobia. A large right temporo-parietal, arteriovenous malformation was detected. The relationship between these disorders is discussed.
Committal law in Ireland
Authors: Gibbons Patrick , Walshe David
Published: March 2016

Legislation governing committal practice has been a cause of controversy worldwide. A review of the relevant literature highlights the ongoing debate between those advocating broadly based ‘need for treatment’ criteria as a basis for committal (‘Parens Patriae’), and those who advocate more narrowly defined criteria requiring evidence of ‘dangerousness’ to validate committal. Current committal law in Ireland follows the ‘Parens Patriae’ tradition. However the recently published Green Paper on Mental Health points out that the current law is not compatible with international obligations, making reform inevitable. The Green Paper suggests various alterations in relation to committal criteria and procedures, with the retention of both ‘need for treatment’ as well as ‘dangerousness’ as valid committal criteria. These changes appear to be compatible with the ‘Stone criteria’ adopted as a model committal law by the American Psychiatric Association.
Non-lithium pharmacological treatment of manic depression: a review
Authors: O'Shea Brian
Published: March 2016

Objectives:To examine the reasons why manic-depressive patients often fail to respond to lithium and, the chief purpose of this paper, to review the present state of knowledge concerning alternative pharmacotherapies to lithium in this disorder.Method:Literature review.Findings:Lithium produces a clinically useful effect in 70-80% of cases. Factors such as non-compliance, side-effects, serum levels, and enduring psychosocial influences on the patient must be considered before treatment failure is diagnosed. Carbamazepine is the most studied alternative drug to date, and the most likely predictors of response to this agent are rapid-cycling, absence of a family history of affective disorder, mania, severe illness, and non-response to lithium.Conclusions:In view of the 20-25% of patients who do not respond to lithium, and the increased likelihood that lithium-responders may fail to respond again once the drug has been stopped for a period, further research is needed to find better and safer prophylactics against depression in bipolar disorders and to refine our knowledge of the indications for use of those already available.
SIADH occuring during benzodiazepine withdrawal
Authors: Meagher Patrick F , Nugent Dermot , Malone Colin
Published: March 2016

A case of inappropriate ADH secretion, water intoxication, convulsion and unconsciousness occurring during abrupt withdrawal of benzodiazepines due to the patient under reporting her consumption is described.
Temporal determinants of language acquisition and bilingualism
Authors: Breathnach Caoimhghin S
Published: March 2016

Modern methods of investigation in conscious subjects have shown that in normal brain, language is catered for by several essential areas localised in the frontal and temperoparietal cortex and by widely dispersed neurones that serve subsidiary, specialised linguistic functions. These sensory specific, phonological, articulatory and semantic ‘modules’ are activated in parallel. A relatively limited amount of language heard during the sensitive period, when one or other cerebral hemisphere usually becomes dominant for language, is all that is required for any normal child to develop fluency. The specific details of the code, or ‘set’, developed are dependent on the language of the child's environment; they are culturally acquired, but the propensity for language is inborn. During this sensitive period, two languages may be as easily accommodated as one. In stark contrast to the acquisition of natural bilingualism, after about the age of 10 years, any new language is acquired with difficulty for it must be translated into the individual's established language or languages. If a nation is to become bilingual, full advantage of the evanescent sensitive period must be taken by regularly exposing the pre-school child, rather than the older child undergoing formal education, to two languages.
A study of violent behaviour by residents in a mental handicap centre
Authors: Keenan Eamonn , Ramsay Louis
Published: March 2016

Objective: The authors were aware of a high level of aggression in their centre and felt that a systematic review of incidents of aggression could be of benefit to both staff and residents. Method: A retrospective review of all incidents over a one year period was performed. Data involving the resident and the incident itself were analysed. An ICD 9 psychiatric diagnosis was attributed to each resident where possible. Results: The results show a large number of incidents, mostly of a minor nature. In almost half the incidents the nurse was the victim. There was a lower number of incidents in January and February. Forty one of the 45 residents involved in incidents had a psychiatric diagnosis. Conclusion: There is a general trend for moving from residential settings to the community. Our results suggest that as time goes on our centre will contain more residents with a psychiatric diagnosis who have a potential for aggression. We suggest ways of coping with this aggression and produce an incident form for recording aggressive incidents.
Services to schizophrenic patients: epidemiological and cost-effectiveness issues
Authors: Williams Richard , Walsh Dermot , Dalby J Thomas
Published: March 2016

Objective: This study is designed to evaluate a hospital based integrated service for the comprehensive delivery of care and treatment to patients with schizophrenia, on epidemeological, cost effectiveness, and quality of life parameters. Methods: All patients with an ICD9 diagnosis of schizophrenia who received services from the St. Lomans Catchment area during a 2 year period were evaluated for service utilization during a subsequent 2 year period. Data was collected on basic demographics for the epidemiological aspects of the study, and for all aspects of services utilized, eg. day hospital attendance, inpatient bed useage, time spent with psychiatrist, community nurse visit or clinic visit. Costs for all services were calculated using disaggregate cost data. Quality of life of the patients was assessed through the Lehman quality of life questionnaire administered to every third identified patient. Results: 572 schizophrenic patients were identified from the case register and case records search. An analysis of the data indicated no difference in age of first contact with services on rural/urban or male/female comparisons contrasting with previously reported findings. Males tend to utilize proportionately more services in both rural and urban settings. Inpatient hospitalizations contributed the most to per patient costs and a small group of patients, comprising less than 5% of the total population, consumed 10% of the total costs consumed by all diagnostic groups and 30% of the costs of all schizophrenics. Non-hospitalized patients experienced the highest quality of life ratings. Conclusions: Hospital based community services to schizophrenics can be run cost-effectively. There remains a small subgroup of schizophrenic patients who are hard to place or treat in the community and they consume a disporportionate amount of the hospital's costs. Services that attempt to establish patients in the community can do so cost effectively provided there are hospital inpatient beds available as a back up. The benefits of this type of comprehensive service delivery to the schizophrenic population served are demonstrated.
A catchment area study of suicides in Waterford in 1990
Authors: O'Dwyer Anne-Marie , Sheppard Noel P , Murphy Maurice N , Horgan Richard
Published: March 2016

Objective: To survey suicides occurring in Waterford City and County in 1990, to calculate a suicide rate for the region and to examine a series of drownings which occurred during the study period. Method: A catchment area study was carried out with information being collected from coroner's reports, police records, postmortem reports and other sources. Cases were defined by clinical criteria. Results: 13 males and 1 female were considered to have died by suicide, giving an estimated suicide rate of 15 per 100,000. Demographic characteristics and prevalence of psychiatric morbidity conformed broadly to national trends. Conclusion: Structuring a study to deal with suicides within a particular catchment area allows ready access to detailed information from local sources and yields information of special interest and significance to the psychiatric services of the area. Study of a series of drownings in young adult males in 1990 which had aroused much local concern illustrates the difficulties in categorising deaths accurately by this method.
Engaging problem drinkers in a general hospital setting
Authors: McDonnell Catherine , Patterson Diana G , Hughes Ann Marie
Published: March 2016

Objective:To determine the level of engagement as defined by return for out-patient appointment in patients referred for alcohol counselling in a general hospital.Method:The hospital was offered a service with counselling within 24 hours for patients who were identified by ward staff as having alcohol related problems. Referred patients were interviewed on the ward by a nurse who specialised in alcohol counselling. Follow-up appointments were offered.Results:60% of those given counselling returned for further counselling as out-patients. 83% of women counselled were engaged compared with 42% of men (p<0.05). The mean SADD (a measure of alcohol dependency) score was 23.9 in those subjects who were engaged and 18.6 in those not engaged (p<0.05), indicating greater dependency in the former group.Conclusions:Although these patients had not actively sought help with their drinking 60% returned for counselling as out-patients. Women and those with high levels of alcohol dependency were more likely to seek further counselling.
Post traumatic stress disorder symptoms in prisoners following a cell mate's hanging
Authors: Freyne Aideen , O'Connor Art
Published: March 2016

Post traumatic stress disorder (PTSD) is a well recognised condition which occurs in people who have been exposed to severe trauma as victims, potential victims or witnesses. A review of case notes of all prisoners transferred since 1988 to a national forensic psychiatric hospital following traumatic hanging events in prison revealed that all patients had psychological symptoms and four had symptoms probably fulfilling PTSD according to DSM III R criteria. Our findings are discussed with reference to the literature on PTSD, the nature of the prison environment, the premorbid personality of prisoners, and the implications for dealing with the effect of suicide within a prison setting.
Remarkable resolution of an uncommon psychosyndrome: epilepsy-induced remission of Cotard's syndrome
Authors: Malone Kevin , Malone John P
Published: March 2016

A case of Cotard's syndrome which resolved following two grand mal seizures is described. This case illustrates how organic factors can be aetiologically significant in psychiatric disease. It also illustrates the usefulness of convulsive therapy, whether prescribed or occurring via nature, in this rare disorder.
Psychiatric hospital staff knowledge and attitudes towards AIDS, and the impact of an in-house education seminar
Authors: McIvor Ronan J , Shelley Rory K
Published: March 2016

A self-administered questionnaire assessing general knowledge about AIDS, including modes of transmission, methods of prevention and attitudes to the disease, was completed by staff in a psychiatric hospital after an AIDS education seminar. The data were used to assess staff knowledge of and attitudes to AIDS, and to assess the usefulness of the seminar in changing these. Responses to individual questionnaire items were examined for associations with age, sex, job description and attendance at the seminar.

Eighty-six staff members returned questionnaires, a response rate of 39%. The results showed that levels of knowledge concerning AIDS transmission and prevention were high. A significantly greater proportion of seminar attenders were aware that needles should not be recapped after taking blood samples, but when this and other knowledge and attitude responses were corrected to allow for the higher proportion of non-medical staff among the non-attenders, there were no significant differences between attenders and non-attenders.

These results suggest that an omnibus AIDS education seminar may not produce a worthwhile improvement in staff knowledge of or attitudes to AIDS.
The psychopathology of acromegaly
Authors: Spence Sean
Published: March 2016

A case of acromegaly presenting as psychotic depression is described. The relationship between psychiatric symptoms and acromegaly is reviewed and the importance of considering an organic diagnosis in a psychiatric syndrome arising de novo in later life is highlighted.
Allegations of child sexual abuse: delayed reporting and false memory
Authors: Byrne Peter , Sheppard Noel
Published: March 2016

Eleven case histories, including diagnoses and outcome, are presented of patients who made, or were the subject of, allegations of sexual abuse, but where these allegations were subsequently withdrawn or disproved. How such situations come about is discussed, with special reference to the false memory syndrome, a term made popular by recent media coverage. Given the complexity of this ‘syndrome’, an argument is put forward that diagnostic guidelines be established so that direct studies of its natural history and treatments may be undertaken.
Dissociative psychosis: an atypical presentation and response to cognitive-analytic therapy
Authors: Graham Candida , Thavasotby Rijan
Published: March 2016

We report on a patient with a rare type of dissociative disorder, dissociative psychosis (hysterical psychosis), in whom gustatory, olfactory, visual and auditory hallucinations occurred. Auditory and visual hallucinations have been described in previous cases of dissociative psychosis, and olfactory and gustatory hallucinations have been described associated with sexual assault but this case is unusual in that hallucinations occur in all modalities in one patient, as yet not described in the literature The basis of the dissociative disorder lay in a childhood sexual trauma and therefore the traditionally advocated treatment for such a case is the psychotherapeutic abreaction of these previous traumatising events. This approach caused worsening symptomatology and the patient experienced frequent lapses into dissociative psychosis. However, focused cognitive-analytic therapy concentrating on the patient's personal conflicts at the time of presentation resulted in a resolution of symptoms and a return to health.
Inpatient liaison psychiatry: the experience of two Irish general hospitals without psychiatric units
Authors: Swanwick Gregory , Clare Anthony
Published: March 2016

Objective: The aim of this study was to examine the provision of psychiatric care to inpatients in two Irish general hospitals without psychiatric units and to comment on (a) how this service model compares with previous Irish studies, (b) whether it meets the goals of liaison psychiatry, and (c) the implications for future service planning. Method: Demographic and clinical details relating to all the psychiatric consultations to inpatients (i.e. there was no emergency service to the casualty department) in two general hospitals were collected over a six month period. Results: Although the service was provided on a nonemergency basis the referral rate [1.6% of total admissions], patient characteristics, reasons for referral, diagnoses, and suggested management strategies were very similar to previous Irish studies. Assessment of deliberate self-harm cases was the most common reason for referral [37.9% of 145 referrals]. Notably, there was a high level of diagnostic accuracy from non-psychiatric colleagues in this liaison model. Conclusions: This study, of a service model characterised by an emphasis on liaison, points to efforts on the part of the psychiatrist to improve communication with medical and surgical colleagues as being of primary importance in the development of general hospital psychiatry services.
Psychiatric sequelae of MDMA (ecstasy) and related drugs
Authors: Cassidy Geraldine , Ballard Clive G
Published: March 2016

Two cases of psychiatric disorder temporally related to the abuse of hallucinogenic amphetamines 3, 4 methylenedi-oxymethamphetamine (MDMA), methylenedioxyamphetamine (MDA) and methylenedioxyethylamphetamine (MDEA) are described, suggesting that a variety of psychiatric morbidity may be precipitated by abuse of these drugs, including paranoid psychosis, mixed affective psychosis and symptoms of obsessive compulsive disorder.
Opiate dependence in acute intermittent porphyria
Authors: Procter Elizabeth A , McKenzie Immanuel P
Published: March 2016

Acute Intermittent Porphyria (AIP) is often accompanied by psychiatric disturbance. Despite routine use of opiate analgesia in the treatment of the acute illness, only one case of dependence is described in the literature. We report a further case where dependence on morphine complicated the assessment and management of a woman with AIP who had been admitted to psychiatric hospital following the death of her child. Clinical implications are discussed.
Naloxone: lack of effect of a very low dose on fluid intake and activity in rats
Authors: Bell Robert , Davis Sheree
Published: March 2016

Opiate antagonists, such as naloxone, have been employed to indicate the possible involvement of endogenous opioids in a variety of behaviours including the pathogenesis of schizophrenia. This paper describes two experiments which were performed to determine the effects of naloxone on fluid intake and activity in rats. In experiment 1, the administration of 1mg/kg naloxone significantly (p<0.001) reduced water intake. 10mg/kg naloxone considerably reduced water intake, although this result was not significant. This influence was transient, since water intake was restored to control levels at the end of the 4 hours test period, and not dose related. A low dose of naloxone 0.01mg/kg produced no effect. In experiment 2, doses of 1 and 10mg/kg did not influence locomotor activity, rearing or grooming in the open field. These results suggest that naloxone may exert a primary antidipsogenic action that does not depend upon any suppression of concomitant activity. Furthermore, mechanisms controlling water intake and activity appear to be dissociated. A speculative role for the endogenous opioid system is discussed.
The role of memory on the dentally anxious patient's response to dental treatment
Authors: Freeman Ruth
Published: March 2016

The aetiology of dental anxiety is multifactorial. Psychologically traumatising events associated with dental treatment have been shown to be of particular importance. The present investigation examines the role of memory in relation to these traumatic episodes and investigates their influence on the patient's response to dental treatment.

The study has shown that patients with dental anxiety have had more experience of “traumatic dental events” (p<0.001), relate the cause of their dental anxiety to specific dental procedures and report more fear of dental treatment than controls. The memories of such traumatic dental events are important indicators of anxiety in the clinical setting, with dentally anxious patients having significantly higher scores for dental anxiety (p<0.001) compared with controls. Furthermore, the memories of these events have a special relevance to the patient's subjective experience of dental anxiety in the here and now. The past event sensitises the susceptible patient and maintains and intensifies the anxiety through a feed-back mechanism, resulting in a vicious circle of anticipatory dental fear.
Female prison transfers to the Central Mental Hospital, a Special Hospital (1983–1988)
Authors: O'Connor Art , O'Neill Helen
Published: March 2016

During the course of imprisonment, whether on remand or when serving a sentence, people sometimes need to be transferred to a psychiatric hospital. In the Republic of Ireland the only psychiatric hospital a person can be transferred to is the Central Mental Hospital (C.M.H.).

We describe 99 female prison transfers to the C.M.H. between 1983 and 1988. The mean age of the 70 sentenced prisoners was 26.43 years and that of the 29 remand prisoners was 33 years. The primary diagnoses were Schizophrenia (11), Mania (7), Depression and Stress (23), Personality Disorder (36), Mental Handicap (2) and Drug Addiction (16). The longest average stay at the hospital was for personality disorders (5 weeks). The longest sentences were for drugs offences. There were no cases of homicide or sex offences. We recommend that many of these cases could be handled in their catchment area hospital rather than in a high security Special Hospital.
Juvenile Huntington's Disease
Authors: O'Shea Brian , Falvey Jane
Published: March 2016

A significant minority of cases of Huntington's disease commence before the age of 20 years and these juvenile cases are more likely to demonstrate paternal transmission and a clinical picture dominated by rigidity. Genetic research and positron emission tomography may make early diagnosis easier but predictive testing in childhood is replete with serious problems. There is no specific treatment for this fatal disorder. Juvenile Huntington's disease has a similar pathology and biochemistry to the adult condition despite a shorter course and certain clinical differences, such as rigidity and convulsions. Racial differences are explored.
Alprazolam: just another benzodiazepine?
Authors: O'Shea Brian
Published: March 2016

The literature on alprazolam is reviewed. It is concluded that it is an effective anxiolytic but that it is not an antidepressant. When used in sufficiently high dosage it can block panic attacks, but it is not the only antipanic agent available. It may be used as an alternative to other benzodiazepines in the acute detoxification of alcoholics. It should be avoided where there is strong individual likelihood of abuse. Chronic usage (more than a few weeks) demands a very slow tapering of dosage. Carbamazepine may ameliorate withdrawal symptoms. The use of alprazolam in other conditions remains unproven.
Improved Subjective Health in Patients in a Post Coronary Rehabilitation Programme
Authors: Conroy Ronan M , Gowan Elizabeth Mc , Mulcahy Risteard
Published: March 2016

We studied the impact of a first myocardial infarction or episode of unstable angina on four areas of subjective health: wellbeing, perceived functional status, body confidence and emotional symptoms. A questionnaire in which the patient was asked to compare status before and after hospital admission was given to 61 cardiac patients attending follow-up rehabilitation clinics.

Worries about health and fears of straining oneself were common in the 24 patients surveyed less than 3 months from discharge. But in patients over 3 months from discharge, sense of wellbeing was significantly improved post-infarction compared with pre-infarction: 86% of patients noting a change reported an improvement. Perceived family role performance was significantly improved, while confidence in work performance and general competence remained unchanged. The prevalences of depression, anxiety and worry were unchanged from pre to post attack, patients in whom these symptoms developed being off-set by patients who lost symptoms.

Previously-reported adverse sequelae of acute coronary disease may exaggerate the extent of the problem. Restriction of studies to neurotic symptoms and failure to compare pre and post attack periods may fail to elicit improvements in quality of life associated with rehabilitation and secondary prevention programmes.

Running Title: Subjective health in post-coronary patients
Who Fails To Attend At The Psychosexual Clinic? No Help From The Referral Letter
Authors: O'Gorman E , Flanlgan P
Published: March 2016

One hundred and sixteen new referrals who attended a psychosexual clinic and one hundred and twenty non-attenders are compared on characteristics derived from their referral letters. Only the widowed and divorced are more likely to attend. It is concluded that non-attendance cannot be predicted from the referral letter.
The effects of relocation on long-stay psychiatric patients
Authors: Ferrari Marie A , Corbett Elizabeth A , Cole Margaret M , Corkery Brid , Dunne David F , Morgan Eugene , O'Sullivan Marie , Buckley Mary E
Published: March 2016

Objective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.
Therapy for stuttering: experimenting with experimenting
Authors: Leahy Margaret M , Collins Geraldine
Published: March 2016

An account is given of an approach to group therapy for stuttering using Kelly's personal construct theory as a basis for exploring the understanding of stuttering and the process of change. All five clients who participated showed considerable improvement in fluency on the Riley Stuttering Severity Instrument. Although the improvement may be due to concurrent individual fluency therapy, feedback on the group sessions suggested that group therapy had a positive effect on personal behaviour and facilitated transfer and maintenance of speech fluency.
Impact of training course in behavioural therapy on psychiatric nurses
Authors: Dunne Elizabeth A. , Melinn Aine , Humphreys Tony , Quayle Ethel
Published: March 2016

A group of psychiatric nurses (N = 15) rated the impact of participation in a one year post-experience training course in behavioural psychotherapy on their personal/family life; professional practice; and professional relationships. Levels of stress associated with different phases of the course were also monitored.

Results indicated that the main stresses were associated with re-adjustment of family life over the period of the course and ensuring stability of training placements at the outset of the course. The course fulfilled participants' expectations with regard to improving their clinical practice, and confirmed their view that relationships with psychiatrist colleagues would be unaffected by their participation on the course. Impact on relationships with nurse colleagues was more positive than had been anticipated during the period of the course.
Psychiatric aspects of acromegaly – a review and case report
Authors: Sivakumar Kandiah , Williams Maureen
Published: March 2016

The case of an acromegalic man who became depressed and developed major behavioural changes, characterised by the onset of pathological gambling is described. The inter-relationship of these conditions and the literature on the psychiatric aspects of acromegaly is reviewed.
Towards a comprehensive Mayo psychiatric service: a preliminary survey of longstay patients
Authors: Garvey Deirdre A , Finnerty Susan M , Smith Eamon J
Published: March 2016

A group of 183 longstay psychiatric patients were evaluated regarding their immediate and future discharge potential in order to assist in the future planning of the Mayo Psychiatric Services. Comparisons were made between new longstay patients, who were defined as those who had been in hospital for greater than one but less than five years, and old longstay patients who were in hospital for greater than five years. Age and sex comparisons were also made.

While 28% of those included in the survey were thought fit for immediate discharge, a further 18% were thought to require further active rehabilitation before discharge into the community within one year. The accommodation requirements of those needing continuing inpatient care are discussed. Age and length of time in hospital were found to be associated with discharge potential. Sex difference was not found to be significant. Implications for the development of the service are dicussed on the basis of the findings.
Factors influencing perception of risk of HIV acquisition among male heterosexual STD clinic attenders
Authors: Bownes Ian T. , O'Gorman Ethna C. , Dinsmore Wallace W.
Published: March 2016

A variety of demographic, psychosocial, intrapersonal and behavioural factors have been shown to influence behavioural change in response to AIDS education. The study investigated perceived risk of HIV acquisition amongst 50 male heterosexual STD clinic attenders and its relationship to knowledge regarding the nature and prevention of transmission of HIV, current sexual practices, relationship difficulties, sexual dysfunction, alcohol abuse and psychiatric morbidity.

The sample demonstrated a good general knowledge about AIDS but there was little evidence of the practice of ‘safer sex’. The overall incidence of psychiatric morbidity was 38%, of problem drinking 52%, of sexual dysfunction 32% and marital/relationship dysfunction 42%. Only 22% felt that their life-style put them at risk of HIV acquisition. It was felt that a narrow emphasis on information in AIDS prevention programmes ignores the powerful effect other factors may have on an individual's motivation to change his behaviour. Evaluation of the cognitions of this at risk group with particular reference to the role of cognitive distortions in perception of risk could provide a means of enhancing the efficacy of future health education campaigns.
Abstinence in treated and untreated opiate abusers: a study of a prison sample
Authors: O'Mahony Paul
Published: March 2016

Twenty-four out of a systematic sample of 95 Mountjoy prisoners were found to have been daily users of opiates. Half of the opiate using prisoners had been abstinent before entering prison for an average of 17.5 months. However, 11 of the total 24 subjects and seven of the 12 abstinent prisoners had not been exposed to any treatment other than detoxification.
Acute dystonia induced by clomipramine therapy
Authors: Chithiramohan R N , Ballard C G , Measey L G
Published: March 2016

We present a case showing inducement of acute dystonia by clomipramine therapy and discuss the possible explanations. We could find no previous reports of this phenomenon.
Toxicity of lofepramine in heart disease
Authors: Johnson Bankole A , McCann Jacinta , Johnson Efunbowale A
Published: March 2016

Lofepramine at the upper limit of its therapeutic range (210mg/day), was associated with the development of sinus tachycardia with atrial ectopic beats and progression of right bundle branch block to trifascicular block in an 82 year old man with a history of heart disease. As with any antidepressant administered in a high therapeutic dose, caution and regular electrocardiographic monitoring of elderly patients with heart disease receiving lofepramine is recommended.
What's Irish about psychiatry?
Authors: Webb Marcus
Published: March 2016

This lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.
Depressive symptoms in opiate addicts on methadone maintenance
Authors: Williams Hugh , O'Connor John J. , Kinsella Anthony
Published: March 2016

Sixty seven opiate dependent addicts receiving methadone maintenance completed the Beck Depression Inventory. A high level of depressive symptoms was found. Eighteen (27%) scored in the moderately depressed range while thirty eight (56%) scored in the severely depressed range. There was no statistically significant association between either sex or HIV status and level of symptom reporting. The clinical implications of depressive symptoms in opiate addicts are discussed.
Female homicide
Authors: d'Orbán P T
Published: March 2016

The incidence, characteristics and patterns of female homicide are reviewed, with special reference to England and Wales. The male:female ratio for homicide offences (7.6) is similar to the ratio for other offences of violence. However, murder is almost exclusively committed by men, and in the 1980's the annual average of female murder convictions was only 6.5 per annum. By contrast, females relatively more often commit homicide offences related to mental disorder (diminished responsibility manslaughter and infanticide). Women have a better chance of acquittal of murder and are more likely to be dealt with by a Probation Order than imprisonment. About 80% of the victims of female homicide are family members; 40-45% kill their children and about one-third kill their spouse or lover. The patterns of female filicide and parricide are reviewed. Further research is required into patterns of spouse-murder.
The Dark Cartoon: Intrusive Imagery Secondary to Childhood Sexual Abuse
Authors: Katsuura Yoshihiro , Russell Vincent
Published: March 2016

We report on the case of a middle-aged woman with a complex psychiatric history in whom atypical intrusive imagery identified in the mental status examination appeared to represent an emergence of childhood dissociative phenomena. These new symptoms led to the reappraisal of her clinical presentation and a diagnostic re-evaluation that they represented a re-emergence of childhood post-traumatic stress disorder secondary to sexual abuse. We discuss the phenomenology identified in our patient with the aim of increasing awareness of unusual symptoms in adults with a history of childhood sexual abuse and the importance of the mental state examination in eliciting and classifying such phenomena.
The Teamworking Challenges of Care Planning
Authors: McHugh Patrick , Byrne Micheal
Published: March 2016

Background: Care planning is a multidisciplinary process used to develop an individualised recovery plan for each service user. The success of this process will depend on the extent to which members of mental health teams can work with one another, with service users, and with other service providers in developing a coordinated plan that meets service user needs across multiple domains.

Aims: This paper examined the teamworking challenges that Community Mental Health Teams (CMHTs) face during the care planning process and how such challenges may be managed.

Method: A narrative review of published articles and policy documents relevant to teamworking and recovery-focused care planning within mental health teams.

Findings: Teamworking challenges include the provision of integrated rather than fragmented care, the empowerment of the service user, and development of a distributed model of leadership, responsibility and decision making.

Conclusions: CMHTs face a range of substantial but manageable challenges in attempting to implement recovery-focused care planning. Recommendations include the need to integrate recovery-orientated skills and values into professional training, the need for greater multidisciplinary training opportunities, and the need to evaluate CMHTs based on recovery-orientated criteria.
Developing an Integrated Mental Health Care Service: Description of a Pilot Mental Health Consultation/Liaison Clinic in a Primary Care Centre
Authors: Ramperti Nicolas , Golden Daniel De La Harpe , Chinedu Iro , O'Casaide Seathrun , Kelly Frank
Published: March 2016

To determine if a consultation/liaison mental health clinic in primary care as proposed for Vision for Change, The Primary Care Strategy and the Department of Health is an efficient model of delivering mental health care in Ireland.

Methods: The pattern of service use and the clinical characteristics of new patients attending a pilot consultation/liaison clinic in a local primary care centre were studied.

Results: During the first 16 months of this clinic 1.2% of patients did not attend the initial assessment in the liaison clinic versus 29.75% in the regular Outpatients Department (OPD). Less than one in five (17.1%) required a follow-up review with the clinician in the consultation/liaison clinic compared to almost all patients first seen in OPD secondary care (96.6%). A small minority of patients (6.1%) needed referral to secondary care due to the complexity of their presentation.

Conclusions: A consultation/liaison mental health clinic in primary care results in an efficient use of manpower resources due to the low Did Not Attend (DNA) rates and low proportion of formal referrals to secondary care. As patients seem to favour this type of setting, over traditional outpatient departments, a move towards consultation/liaison clinics in the primary care team should be considered.
Situational and psycho-social factors associated with relapse following residential detoxification in a population of Irish opioid dependent patients
Authors: Ducray Kevin , Darker Catherine , Smyth Bobby P
Published: March 2016

Aims:To identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme.

Design, participants, setting:Prospective follow-up study of consecutive detoxified opioid dependent patients treated in a specialist inpatient drug dependency unit.

Measurements:The Maudsley Addiction Profile and a structured interview were administered to 109 patients, 18–36 months after discharge.

Findings:Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%).

Conclusions:Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.
The Vron – An Early Intervention In-patient Recovery Unit
Authors: Macpherson Rob , Peddu Pradeep , David Chris
Published: March 2016

Background and aims: This paper describes the context in which the Vron, a six-bedded 24-hour nursed care unit, has developed its role from a fast track rehabilitation unit, to work explicitly within an early intervention service. The study aimed to evaluate the work of the Vron by examining the change in CANSAS, HoNOS and EM scores between admission to and discharge from the unit.

Results: Approximately half of the admissions to Vron were from acute psychiatric wards. Most patients were discharged to their own tenancy or supported accommodation. There was a significant reduction in mean HoNOS score and increase in mean EM score during admission. Mean staff and patient-rated unmet needs reduced in the course of admission. In the course of admission, approximately half of the patients developed occupational roles.

Discussion and conclusions: The findings of this service evaluation must be interpreted with caution in view of the methodological limitations, in particular the lack of a comparator service intervention. However, it is suggested that units of this type may have a useful role in the rehabilitation of patients with complex severe mental illness, particularly if deployed at an early stage in an individual's illness, to prevent development of disability. The Vron focuses on a number of specific clinical and social areas which align with typical strategies in early intervention.
Did the Great Irish Famine increase schizophrenia?
Authors: Walsh Dermot
Published: March 2016

Background:Evidence from regions where there have been severe dietary restriction suggests that individualsin uteroduring periods of starvation may subsequently be at increased risk of schizophrenia. Because Ireland was the location of a major nineteenth century famine an attempt has been made to determine whether any such evidence for famine/schizophrenia association can be found.

Method:The data used derive mainly from the Annual Reports on the District, Criminal and Private Lunatic Asylums supplied by the Inspectors of Lunacy in Ireland for the relevant years. Nineteenth century diagnostic labels have been adjusted to conform to schizophrenia as currently understood. Evidence relating to a possible schizophrenia increase in famine-related emigrants is examined.

Results:There was an increase in first admission rates for schizophrenia of 85.7% from 1860 to 1875. Admissions for other disorders, chiefly melancholia, also increased. Similar admission increases were evident in other jurisdictions over the same period. Data relating to the mental health of famine – migrating Irish are sparse and of difficult interpretation.

Conclusion:The evidence from available data sources attempting to link the Irish famines of the 1840s with a subsequent increase in the incidence of schizophrenia is equivocal and inconclusive.
Mental illness among the homeless: prevalence study in a Dublin homeless hostel
Authors: Prinsloo Bernice , Parr Catherine , Fenton Joanne
Published: March 2016

Objective: To determine the prevalence of mental illness among the residents of a homeless hostel in inner city Dublin.

Method: A cross-sectional survey was carried out among hostel residents, as previous studies have indicated that homeless hostel-dwelling men in Dublin constitute the largest single grouping of homeless Irish people. All agreeable residents were interviewed by the authors over an eight-week period using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Clinical Version. For each disorder, the current (30-day) and past prevalence was determined.

Results: A total of 38 residents were interviewed, resulting in a response rate of 39.2% for the study. A total of 81.6% of residents had a current Axis I diagnosis; this number increased to 89.5% when combining current and past diagnoses. Only four residents had no diagnosis. There was considerable comorbidity between disorders, with a significant number of residents experiencing both mental illness and substance use problems. When considering lifetime diagnoses, 31.6% had a single diagnosis only; 57.9% had two/more diagnoses. Twelve residents (31.6%) had been admitted to a psychiatric hospital during their lifetime. The most prevalent disorders during the past month were Alcohol Dependence (23.7%), Opioid Dependence and Major Depressive Disorder (both 18.4%), Opioid Abuse and Alcohol-Induced Depression (both 7.9%). Only 23.7% of interviewed residents were attending psychiatric or addiction services. A significant number of residents who did not wish to participate in the study were identified by hostel staff as having a confirmed psychiatric diagnosis.

Conclusion: The survey demonstrated a very high prevalence of mental disorders among homeless hostel residents. The high prevalence of dual diagnosis highlights the need for greater collaboration between psychiatric services and addiction services. The outcome also points to the importance of providing mental health training to emergency shelter/hostel staff. Research into the mental health status of the homeless should be undertaken regularly if services are to be planned to meet the needs of this vulnerable group.