bluuebunny/crossref_metadata_2025 huggingface dataset:
The day hospital in psychiatry of old age – what difference does it make?
Authors: Corcoran Eleanor , Guerandel Alice , Wrigley Margo
Published: March 2016

Objective: Two day hospitals were established in North Dublin in 1989 to play a key role in the first old age psychiatry service in the Republic of Ireland. The purpose of this study was to identify the characteristics and needs of day hospital attenders, to carry out a preliminary evaluation of the role of the day hospitals in meeting these needs, and make recommendations for future developments. Method: All 237 regular attenders between March 1989 and 1992 were included. Demographic, social, medical and psychiatric data including CAGE questionnaire, Folstein mini-mental state, and Clifton Assessment Procedures for the Elderly survey version, were recorded at initial assessment. Data on duration and outcome of attendance, use of inpatient, general hospital and community care services were collected from a retrospective study of records and subjected to statistical analysis. Results: The average age was 78 years (SD 6yrs); 139 (59%) patients had organic and 98 (41%) had functional psychiatric disorders; 198 (84%) patients had a medical problem. In the functional group, 24 (25%) required acute admission; 70 (71%) patients were managed in the community. Twenty eight (29%) patients required residential care or had died on average 8 months after initial contact. In the group with dementia 104 (75%) had CAPE scores C/D/E at initial assessment, indicating high dependency. Eighty eight (63%) patients were in residential care or dead on average 8 months later. Conclusions: Day hospital treatment enabled elderly patients with functional psychiatric illness to be treated in the community with low usage of beds. It provided only short/medium term care for patients with dementia, who had little support from statutory services. A comprehensive network of services is necessary to support highly dependent patients in the community.
A sceptical reflection on the diagnosis of multiple personality disorder
Authors: Aldridge-Morris Ray
Published: March 2016

Multiple personality disorder (MPD) is being diagnosed with increasing frequency, especially in North America. However, soaring estimates of its current prevalence are accompanied by considerable controversy and heated debate. The author presents a number of grounds on which it seems reasonable to base a sceptical view of the validity of this disorder as a naturally occurring diagnostic entity.
Capgras syndrome associated with a frontal lobe tumour
Authors: Durani Shiban K , Ford Rodney , Sajjad S H A
Published: March 2016

We report a case of the Capgras Syndrome in a 67 year old woman who was found to have a glioma of the left frontal lobe. Our case illustrates the multiplicity of possible aetiological factors which frequently coexist in this condition and make any assessment of possible pathogenetic mechanisms difficult. However, there appears to be a consensus of recent neuro-imaging studies that frontal lobe pathology may be important. The possible relevance of this is discussed together with a suggestion for further elucidation of the origin of the delusion.
Bio-psycho-social interactions in anxiety and panic disorders: a speculative perspective
Authors: Lader Malcolm
Published: March 2016

Anxiety states comprise three components, the subjective, the physiological and the behavioural. Anxiety disorders differ from normal anxiety in that cognitive clues inducing the emotion are covert. Anxiety can be induced by a variety of chemical agents, including the catecholamines, caffeine, lactate and some beta-carbolines. Models can be built up from the standpoints of Schachter, Lader and Matthews, and Clark to provide a cohesive theoretical framework for anxiety and panic disorders. Both pharmacological and psychological treatments are effective in these conditions and the model can incorporate the mode of action of these therapies. The ultimate goal is a holistic concept of anxiety combining the bio-psycho-social approaches.
Recombinant DNA and the major psychiatric disorders
Authors: Gill Michael
Published: March 2016

The two major psychiatric disorders, schizophrenia and the major affective disorders are among the most common genetic conditions in man. The precise biochemical defects which cause these disorders are unknown. This article reviews the new recombinant DNA techniques and their application to date in attempting to locate the genes responsible for these disorders. As has been demonstrated for other genetic conditions, these techniques may help to elucidate the biochemical defects which lead to the development of the more genetic forms of these psychiatric illnesses.
Saussure and psychoanalytic feminism — a made match
Authors: Cox Olga
Published: March 2016

Over the past thirty years Lacanian psychoanalysis, by mapping psychoanalytic concepts onto the terminology of modern linguistics has seemed to radically alter the former, and to a large extent has done so. However, Lacan's insistence that we are formed by, and enmeshed in, language, occults an opposite truth; one that is evidenced by the history of politics and of art, and although psychoanalysis has traditionally remained rigidly apolitical, concentrating on the private and familial rather than the public sphere, it can hardly avoid, even in this sphere, a confrontation with the politics of feminism. Because of its particular appropriation of ‘word’ and ‘language’, Lacanian psychoanalysis finds itself in a contraditory position here. In the private sphere it liberates the little girl by the true ‘word’, while continuing to maintain, in the wider world of language, a now archaic discourse which subsumes both discourses into one, masculine one.
The effect of antidepressant treatment on alpha2 adrenoceptor function in DSM 111 major depression
Authors: Barry Siobhan , Dinan Timothy G.
Published: March 2016

Twenty-one drug free patients fulfilling the DSM-111-R criteria for major depressive disorder were administered an alpha2 adrenoceptor challenge test. They were then treated with an antidepressant or ECT. Six weeks later, alpha2 function was again tested and found to be universally downregulated in treatment responders. Those who failed to respond to treatment (33%) had evidence of continuing alpha2 adrenoceptor activity. These results suggest central noradrenergic overactivity as a possible mechanism for depression, which runs counter to the classic catecholamine hypothesis.
Significant life events and pulmonary tuberculosis
Authors: D'Arcy Mary , Keane Petrina , Clancy Luke
Published: March 2016

The relationship between significant life events and pulmonary tuberculosis was studied with a view to ascertaining whether such events were more prevalent in patients with tuberculosis than in patients with other respiratory diseases. The study was carried out at Peamount Chest Hospital, Newcastle, Co. Dublin. Sixty-five patients with pulmonary tuberculosis and 45 patients with non-tuberculous respiratory diseases were interviewed. We found that there was a significant increase in life events in patients with active tuberculosis when compared with non-tuberculous patients.
The patient and the community: priorities for protection
Authors: Taylor Pamela J
Published: March 2016

Man functions both as an individual and as part of his group, the two roles sometimes leading to conflicting needs. If mental disorder contributes to such conflict then a psychiatrist may be expected to take a leading role in arbitrating between the needs and rights of the individual patient before him and the needs and rights of society. This is not an easy task. This paper seeks to clarify the range of roles the psychiatrist may have to adopt when attempting such a task: his role as an individual, as a member of the general public, as an agent of the patient, as an agent of the patient's representative or even as an agent of state authority or society. Some of the dilemmas that arise in each of these roles are discussed.
Further support from an Irish psychiatric hospital for lack of value of routine serological tests for syphilis
Authors: O'Neill Therese , McCaffrey Brian
Published: March 2016

Since the establishment of St. Brendan's Hospital in 1815 many changes have been seen in the pattern of psychiatric illness but none as dramatic as that of neurosyphilis. When Professor John Dunne first worked there in 1922, 20% of the patients suffered from general paralysis of the insane (G.P.I.) for which there was no cure. Around this time Wagner Von Jauregg – a Viennese physician, observed that patients who had suffered malaria during war did not suffer from G.P.I. He introduced malarial therapy successfully for which he received the Nobel Prize in 1927. Professor Dunne introduced this therapy into St. Brendan's after visiting Wagner Von Jauregg in Vienna. Unfortunately the mosquitos used would not bite! He resorted to injecting malarial infected blood. Only benign tertian malaria was effective and it is believed that the high temperatures induced – 40-41°C killed the spirochaete. This was followed by quinine treatment for malaria. The treatment was very successful but superceded in latter years by penicillin. The incidence of syphilis fell dramatically from 1942-1977, although recently it has been reported that it is rising in females and heterosexual males.

One hundred consecutive samples routinely tested for syphilis (using the Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Haemagglutination (TPHA) test), between January and April 1988 were examined. Ninety-eight were negative for VDRL and TPHA. Two patients, both male, revealed evidence of previous infection i.e. VDRL neg, TPHA positive with Fluorescent Treponema Antibody tests (FTABS) reactive and FTA IGM negative in both cases. Neither of the two patients had any signs or symptoms suggestive of neurosyphilis.
Gasser
Authors: Breathnach C. S.
Published: March 2016

Herbert Spencer Gasser (1888-1963) deserves to be remembered for introducing the oscilloscope into biology and medicine; with a prototype still in the early stages of development he overcame the evanescent nature of the nerve impulse and thus opened the way to the study of cellular electrical potentials in the nervous system. In tracing the origins of the cortical extracellular currents reflected in the waves of the scalp electroencephalogram the oscilloscope has been indispensable.

The graphic methods developed in the nineteenth century were adequate (indeed, admirable) for recording events that were measured in seconds but even the Einthoven string galvanometer that conquered millivolt changes was defeated when the unit on the time scale was the millisecond. The stream of electrons from the cathode in an evacuated (Crookes) tube, which incidentally excited X-rays in Roentgen's tube and served for amplification purposes in the thermionic valve, provided the answer. Progressive refinement of Karl Ferdinand Braun's (1850-1918) original 1897 invention into the cathode ray oscilloscope had the versatility required to follow biological processes that had previously been inaccessible because of the exceeding brevity of their duration. The realisation that the oscilloscope would capture fleeting clinical and experimental events we owe to Herbert Gasser.

Herbert Spencer Gasser was born on 5 July 1888 in the small Wisconsin town of Platteville. After local schooling he entered the nascent medical school of the University of Wisconsin at Madison where Joseph Erlanger (1874-1965) had just set up the department of physiology. After completing his clinical under-graduate course at Johns Hopkins Medical School in 1915 Gasser returned for a year to Madison before rejoining Erlanger who had moved in 1910 to Washington University in St. Louis.
An Unusual Variant of Folie à Deux?
Authors: Casey Patricia , Corcoran Fidelma
Published: March 2016

This paper describes a husband and wife sharing bizarre beliefs, which were felt to result from Pseudologia Fantastica rather than delusions in the inducer (the wife).
The clinical characteristics of patients with obsessive compulsive disorder: a descriptive study of an Irish sample
Authors: Lucey James V , Butcher Gerard , Clare Anthony W , Dinan Timothy G
Published: March 2016

Objective: To describe the clinical characteristics and demographic details of a sample of patients with a principal diagnosis of obsessive compulsive disorder (OCD). Method: A retrospective review of fifty patients with DSM-III-R OCD referred to the Department of Behaviour Therapy at St. Patrick's Hospital, Dublin, Ireland between 1990 and 1991. Standard clinical ratings were made before and after treatment. Ratings used included the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ), and the Yale-Brown obsessive compulsive score (YBOCS). Results: The male to female ratio was almost equal and the mean duration of illness was 6.1 (SD 11 years). OCD presented in isolation in a minority of cases (14%). A life time history of at least one other DSM-III-R axis I diagnosis, especially depression, was found in 72% of patients. Co-morbid Gilles de la Tourettes syndrome or epilepsy was rare. The majority of patients were on medication prior to presentation (78%). Levels of symptomatology were reduced in 91% of patients who completed treatment. Conclusions: Epidemiological research into the mass aspects of this disorder is required.
Depression in anabolic steroid withdrawal
Authors: Cowan Colin B
Published: March 2016

A case is described of a severe depressive episode following withdrawal from anabolic steroids which were being misused to enhance body-building. The subject was a twenty-two year old unemployed male who had left school without formal qualifications and had been brought up by his grandparents since his parents' separation. He had been a bodybuilder for four years and misused combinations of oral and parenteral anabolic steroids in increasing doses for two years. His depressive symptoms included lowered mood, loss of energy, anhedonia, suicidal preoccupations, disturbed sleep, poor appetite and impaired concentration. It is proposed that unusually prolonged exposure to steroids followed by withdrawal was the most likely cause of the depression in this case and that biological vulnerability to affective disorder may explain the severity of the episode. Misuse of steroids needs to be considered in young physically active people presenting with depression.
Musical hallucinosis: auditory Charles Bonnet syndrome?
Authors: Hosty Gary
Published: March 2016

A case of musical hallucinosis is presented, which failed to respond to neuroleptics but responded to carbamazepine. Parallels with the Charles Bonnet syndrome are discussed.
Delusional disorder in tropical spastic paraparesis
Authors: Mahmood Ahmed , Brennan Anthony , Stanley Anne , Ballard Clive G , Malik Athar , Mohan Ramalingam N C
Published: March 2016

A case of delusional disorder in a patient with the demyelinating disease tropical spastic paraparesis is presented. Only one similar case has previously been described. The implications are discussed.
Canine Capgras
Authors: Wright Barry , Mindham Richard , Burn Wendy
Published: March 2016

Two separate cases are reported in which a woman believed that her pet dog had been replaced by an identical double. The psychodynamic issues which these reports raise are discussed. In the Capgras delusion the double is usually a key figure in the life of the patient. These reports highlight the fact that this key figure may be a domestic animal.
Familial dementia with Pick's cells – a case report of probable familial Pick's disease
Authors: Gaughran Fiona , Keohane Catherine , Buckley Mary
Published: March 2016

The clinical and pathological features are described in a case of prolonged dementia in a 59 year old man with familial dementia and extrapyramidal disorder. Postmortem examination showed severe fronto-temporal and basal ganglia atrophy, with many “ballooned neurons” in the residual cortex most likely representing Pick's disease. The differential diagnosis is discussed and aspects of this rare condition are reviewed.
Audit of new long-stay patients in a district general hospital
Authors: Kurian Mathew , George Shobha , Ballard Clive G , Mohan Ramalingam NC , Cumella Stuart
Published: March 2016

Objective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.
Attitudes of general practitioners to the psychiatric services
Authors: Watters Liam , Gannon Miriam , Murphy Denis
Published: March 2016

Structural Abstract

Objective: General practitioners play a crucial role in the delivery of psychiatric treatment to patients who have many similarities to those attending the general psychiatric services. The purpose of this study was to elicit attitudes of general practitioners to an existing local service. Methods: We used an anonymous questionaire hand delivered to 54 general practitioners with practices in the catchment area of one of Dublin's psychiatric hospitals. Results: We received responses from 40 of the GP's indicating a high level of psychiatric morbidity in the primary care setting, a moderate level of satisfaction with psychiatric service, a low level of knowledge of the catchment area system, limited interest in taking on an increased role in the care of psychiatric patients and a high popularity rating for the community psychiatric nurse. Conclusions: This study confirms previous estimates of psychiatric morbidity in general practice, a need for improved communication between psychiatrists and general practitioners to identify more realistic expectations on both sides of the equation, and a huge potential for the expanding community psychiatric services to improve liaison between general practitioners and psychiatrists and yield considerable patient and doctor gains.
Hitzig
Authors: Breathnach Caoimhghin S
Published: March 2016

Edouard Hitzig [1838 – 1907] may have been an autocratic, proud and overbearing psychiatrist, but his pioneer work in using electrical stimulation changed utterly the approach to research into the localisation of function in the cerebral hemispheres. If he was vain he had much to be vain about.
Irish general practice and clinical psychology
Authors: Aherne Declan , Griffin Michael
Published: March 2016

This paper reports on client satisfaction and other benefits of having a Clinical Psychologist attached to a General Practice. A review of the existing literature on this topic is presented, based mainly on the British experience. The results of a survey carried out on clients who attended the Clinical Psychologist are presented. These results suggest that there are significant benefits of having a Clinical Psychologist working closely with a General Practitioner. Finally both authors give their own personal comments on the work that they do.
Sudden deaths of patients in a mental handicap hospital
Authors: Simpson J , McFarland E , Calvert GJ
Published: March 2016

One Hundred and two sudden or traumatic deaths of mental handicap inpatients were examined retrospectively over a 28 year period. Data was obtained on each case from medical and nursing case notes and death certificates. Post-mortem results were available for half of the deaths. Cardio-vascular causes accounted for 50% of the total. Sudden deaths of profoundly handicapped patients occurred at a significantly younger age than severely, moderately or mildly handicapped patients. In the latter half of the 28 year period there was an increased incidence of traumatic deaths and sudden deaths due to asphyxia. There was also a significant increase in the mean age of sudden deaths due to epilepsy. Probable explanations for these findings are discussed. In particular, recent accidental traumatic deaths may be related to the process of increased reintegration of patients into the community; a relationship between neuroleptic and anticholingeric medication and asphyxial deaths is proposed.
A pilot study of the effects of early intervention on clinical symptoms and social functioning in psychiatric emergencies
Authors: Tyrer P , Merson S , Harrison-Read P , Lynch S , Birkett P , Onyett S
Published: March 2016

A pilot study of the effects of early intervention by a multidisciplinary community team in patients presenting as psychiatric emergencies to an inner London teaching hospital (St. Mary's) is described. Of 22 consecutive emergency referrals, 20 agreed to be formally assessed, 18 were successfully engaged and 16 had assessments of symptoms and social functioning assessed over a four week period. There was significant improvement in clinical symptoms but no important changes in social functioning. The discordance between improvement in social function and symptoms was unexpected and may reflect the unusual social circumstances of life in metropolitan London or be a consequence of the high proportion (55%) of patients seen with personality disorders.
Father-perpetrators of child sexual abuse who commit suicide
Authors: Walford Geraldine , Kennedy Marie-Therese , Manwell Morna K. C , McCune Noel
Published: March 2016

Two cases of fathers who committed suicide following the revelation that they had sexually abused their own or other children, are described. The importance of being alert to the possibility of suicide and suicidal acts by family members following a disclosure, is emphasised. Improved liaison and co-ordination between agencies working with these families may enable vulnerable cases to be more readily identified and consequently offered appropriate support and treatment.

The revelation that the father in a family has sexually abused his own or other children often precipitates a crisis within the family. The distress suffered by the children themselves and by their mothers is well documented. (Browne and Finkelhor, Hildebrand and Forbes). Goodwin reported suicide attempts in 11 of 201 families, in which sexual abuse had been confirmed. Eight of the attempts were made by daughter-victims. In three of the five cases of mothers who attempted suicide, the abuse was intrafamilial. The impact on father perpetrators, previously a less well researched field, has been receiving more attention of late. Maisch, in a sample of 63 fathers convicted of incest reported that two fathers subsequently committed suicide. Wild has reported on six cases of suicide and three of attempted suicide by perpetrators following disclosure of child sexual abuse. The Cleveland Inquiry Report mentions one father, charged with several sex offences, who committed suicide while awaiting trial. A recent letter to The Guardian newspaper (18th February 1989) by 11 local paediatricians in that area suggests that there are now two such cases of suicide committed by alleged perpetrators.
Aspects of psychological intervention with breast cancer patients
Authors: Timms Michael W H
Published: March 2016

The paper makes a chronological review of the literature in the area of psychological intervention with cancer patients, focussing particularly on breast cancer as this is the disease which has attracted most attention from mental health profesionals. Initially, surveys which identify psychological distress in cancer patients are reviewed, as it is felt that these may have contributed the impetus for intervention. In the second half of the paper, interventions are classified and reviewed.
A study of the prescribing of psychotropic drugs in a Dublin psychiatric hospital
Authors: Murphy Denis J , Gannon Miriam A. , Fitzpatrick Declan , Kumar Rajendar , Doyle Harry , O'Boyle James H , McGennis Aidan
Published: March 2016

To date there has been no study of prescribing habits in a psychiatric hospital in Ireland, as has happened elsewhere.

In a survey over one weekend at St. Brendan's Hospital, the prescription sheets and case notes of all 772 patients were examined.

The principal findings were polypharmacy, the use of benzodiazepines for disturbingly long periods of time, the preponderant prescription of drugs by their proprietary names and the extensive use of neuroleptics for apparently non-psychotic conditions. These results are discussed in the light of other similar surveys.
“Is violence a contagious disease?” The social implications of post-traumatic stress disorder
Authors: Watson Ian P. Burges
Published: March 2016

Some problems related to the formal diagnosis of Post-Traumatic Stress Disorder (PTSD) and the social implications of the concepts incorporated in the diagnosis are addressed. Increasing worldwide evidence of the circumstances likely to produce a PTSD and of patients of all ages and races satisfying the criteria for the diagnosis suggests a problem of epidemic proportions requiring intensive study.
The pharmacotherapeutic management of rapid cycling affective disorder: an update
Authors: Schifano Fabrizio
Published: March 2016

In the present work the author presents a literature update regarding the pharmacotherapeutic management of rapid cycling affective disorder. This phenomenon is characterized, according to Dunner and Fieve (1974), by the presence of at least four affective episodes per year. After a consideration of the clinical features of the disorder, which are in many respects similar to those of the ‘classic’ bipolar disorder, the author describes the different therapeutic strategies available to the psychiatrist. Withdrawal of antidepressant therapy and administration of lithium salts are likely to constitute the best initial approach. In case of treatment non-responsiveness, it is possible to consider the use of different drugs; for example, carbamazepine, sodium valproate, clorgyline, thyroid hormone. To date, the therapeutic management of rapid cyclers remains extremely difficult. Further studies, especially addressed to the aetiopathogenetic aspects of the disorder, are required.
Using Quantitative Research to Measure Recovery Outcomes and Correlates
Authors: Lavin Deirbhile , Ryan Patrick
Published: March 2016

Objective: Recovery has become an increasingly significant concept within mental health literature. Despite this, few studies have investigated the measurement of recovery and its correlates using quantitative methods. The aim of the current study was to measure recovery in people with chronic psychiatric disabilities using a quantitative tool and to investigate what factors were correlated to recovery outcomes. It was hypothesised that measures that investigated the individual's subjective sense of well-being would have a stronger correlation to recovery than more traditional clinician-rated scales.

Method: Participants were 63 people with a chronic psychiatric disability. They were recruited as a convenience sample from community mental health rehabilitation teams in three locations. Using a cross-sectional design, participants completed measures of psychological well-being (Psychological Well-being Scale (PWB); hope (Adult State Hope Scale) and recovery (Recovery Assessment Scale (RAS). Health professionals rated participants' psychosocial functioning using the Multnomah Community Ability Scale (MCAS-R).

Results: Analyses found that there was no significant correlation between clinician-rated psychosocial functioning scores and participant-rated recovery outcomes. Psychological well-being variables rated by the participants themselves were found to significantly correlate with recovery outcomes. The variables hope, environmental mastery and relationships with others were found to emerge as independent predictors of recovery scores.

Conclusions: Results underscore the premise that recovery is a distinct construct that is unique to the individual and cannot be fully captured by objective measures of functioning. Implications for practice suggest that services for people with chronic psychiatric disability should utilise recovery focused tools in patient assessment and treatment in order for a comprehensive assessment to be achieved. Recovery interventions should also focus on the individual's hope, mastery and relationships with others in order to promote recovery.
A Qualitative Study of Gender-Based Pathways to Problem Drinking in Dublin, Ireland
Authors: Cunningham Joanne
Published: March 2016

Objective: High rates of alcohol-related harm have been reported in the European Union, including Ireland, for more than 20 years. This article's goal is to contextualise such rates by examining gender-based pathways to alcohol use disorders from the perspective of those self-identifying as in recovery using data collected midway through this 20-year trend.

Methods: Sixteen informants (nine men and seven women) were interviewed between 1998 and 1999 in Dublin, Ireland. Using qualitative methods, informants were asked to reflect upon their experiences of problem drinking and recovery.

Results: Drinking expectancies, pub-based socialising, social anxiety and perceived social expectations to drink were cited as common pathways to problem drinking by informants, highlighting contradictions in drinking practices and the symbolic functions of alcohol. Drinking contexts identified by informants were public pub-based drinking for men and home-based drinking for women. Primary barriers to problem acceptance centered on pub-based socialising norms and gender-based shame. Benefits of support group membership included establishing new social networks and learning alternative ways to cope with negative emotions.

Conclusion: Consideration of drinking expectancies, the social contexts in which problematic drinking occurs, gender ideologies, the cultural meanings of drinking behaviours, and attention to feelings of isolation or loneliness experienced by those exhibiting problematic consumption behaviours might further understandings of potentially harmful drinking, especially in periods of economic uncertainty.
Steroid-Induced Mania: A Case Report
Authors: Cassidy Carol , Sahay Shobhna , McNicholas Fiona
Published: March 2016

Corticosteroids are commonly used in the treatment of a variety of medical conditions in children and adolescents. However, adverse psychiatric side effects can occur which pose challenges in treatment of medical conditions. This case highlights some of these challenges, in particular the treatment of steroid-induced psychiatric complications in Acute Lymphocytic Leukaemia (ALL). It also accentuates the importance of awareness among pediatricians of the potential adverse psychiatric effects when prescribing corticosteroids in this age group. Families need to be advised accordingly to ensure early recognition and treatment.
The Challenge of Managing Severely Ill Patients with Anorexia Nervosa in Ireland
Authors: Maher Caroline , Nwachukwu Izu
Published: March 2016

Anorexia Nervosa (AN) has the highest rates of morbidity and mortality of any psychiatric disorder. Psychiatrists in Ireland have reported difficulties in managing patients with AN, particularly those with severe levels of illness. This paper explores these management difficulties, including the financial and organisational impediments to service provision, and the legal and ethical dilemmas involved in dealing with those patients who refuse treatment.
Psychiatrists: An Endangered Species? A Study to Observe Attitude of Fifth Year Medical Students to Psychiatry and to Compare Change in Same after a Psychiatry Posting During Medical School
Authors: Johnson Navroop , Lyons Declan
Published: March 2016

Objective:This study was conducted to gauge the attitude of fifth year medical students to psychiatry as a potential career choice and to determine if an eight-week clinical attachment had any impact on this.

Methods:We surveyed a cohort of fifth year medical students from Trinity College Dublin. A purpose designed, self-completed questionnaire was used to establish a number of variables and was given to students on the first and last day of their attachment in psychiatry. Participation was optional and responses were confidential. Questionnaires were distributed following an explanation of the purpose of the study.

Results:The survey was applied to 118 fifth year medical students. The most significant finding of the study was the increase in number of students choosing psychiatry (17%) as a possible career upon completion of the attachment as compared to before (4%). The majority of the students considered psychiatry as a mainstream specialty with little change in this perception pre and post attachment. Almost all of the students believed that a psychiatry posting would improve their communication skills when dealing with patients.

Approximately half of students chose medical subspecialties as career choice prior to their psychiatry posting but this declined afterwards. There was a small increase in the number of students wanting to become GPs and those who were undecided about their potential career choice.

With regards to deterrents to doing psychiatry, the principal one was the belief that psychiatry was too depressing and stressful. Lack of interest, adverse career prospects and financial considerations featured in a minority of student answers.

Conclusions:The findings of this study suggest that psychiatry remains less attractive to students as a career compared to some other specialities but a clinical attachment may be an important means of raising interest in psychiatry as a career.
Child and Adolescent Mental Health Services in Laois/Offaly: A One Year Perspective of Services (July 1, 2008 to June 30, 2009)
Authors: Church Heather
Published: March 2016

Objectives: To examine the Laois/Offaly Child and Adolescent Mental Health Services (CAMHS), focusing on new referrals and trends in the service.

Methods: Data was collected over a one-year period from July 1, 2008 to June 30, 2009 using the computer system MAISY (Medical Audit Information System) and through chart reviews. A Client Satisfaction Survey was administered to both parents and children.

Results: The Laois/Offaly CAMHS team provides service to a total population of around 140,000, of which around 32,000 are less than 16 years old. In this one-year period, 303 referrals were received with 167 offered an assessment, of which 150 availed of an appointment. Forty-six percent were offered appointments within one week of receiving the referral with 87% being assessed within one month. A further 41 were assessed from a previous waiting list, compiled prior to the actual study period, thus resulting in a total of 191 assessments.

Thirty referrals required assessment only. Behavioural/Emotional difficulties and Attention Deficit Hyperactivity Disorder (ADHD) were the most common reason for referral. During this time the ADHD waiting list was suspended due to staff constraints. Seventy-six percent were diagnosed with an Axis I disorder with 34% given medication treatment. Of the return appointments over the year, eight percent of patients did not attend (DNA). Both parents and children reported being satisfied with the service, according to the Client Satisfaction Survey.

Conclusions: The Laois/Offaly team services a catchment area of approximately three times the number recommended by A Vision for Change, with a staff equivalent less than the number recommended for one whole team. The team was able to provide a rapid service for assessment of new referrals, with the ADHD waiting list suspended. Axis I pathology was often diagnosed among those assessed (around 75%), with about one-third being treated with medication. Follow-up appointments achieved a high attrition rate, with only around eight percent not attending. Patient satisfaction with the service rated high by both parents and children.
Delayed Onset of Neuropsychiatric Effects Associated with Montelukast
Authors: Byrne Fintan , Oluwole Bolarinwa , Whyte Vanessa , Fahy Sabina , McGuinness Delia
Published: March 2016

Montelukast (a leukotriene receptor antagonist) is a commonly prescribed medication used in the management of asthma in both children and adults. It has been associated with a possible increased risk of various neuropsychiatric events in post-marketing analyses of clinical trial data and surveillance studies. When establishing a link between a medication and side effects, it is usual to establish and enquire whether there is a chronological relationship between the commencement of the medication and the onset of the symptoms.

We report a case where a number of unusual neuropsychiatric events were reported several years after commencement of montelukast in a young boy who may have a genetic predisposition and a likely psychological trigger. There was complete resolution of these symptoms upon the withdrawal of montelukast.
Benzodiazepine and Z-drug Prescribing for Elderly People in a General Hospital: A Complete Audit Cycle
Authors: Dolan Catherine , Omer Sami , Glynn Deirdre , Corcoran Michelle , McCarthy Geraldine
Published: March 2016

Background: Use of benzodiazepines and Z-drugs in the elderly is associated with adverse outcomes such as increased risk of falls and fractures and cognitive impairment. We aimed to assess the prescribing practice of benzodiazepine and Z-drugs in those aged over 65 years in a general hospital against evidence based standards and to examine the effects of multidisciplinary feedback, as well as determine the prevalence of usage.

Methods: All case-notes and medication charts of patients over the age of sixty five on surgical and medical wards in Sligo General Hospital (SGH) were retrieved and analysed over a two-day period in 2008. Data was collected in relation to benzodiazepine and Z-drug prescribing. We followed up on this initial data collection by screening discharge summaries at six weeks to assess benzodiazepine and Z-drug prescribing on discharge. Audit results were disseminated together with consensus guidelines on the prescribing of these medications in older adult population to all general practitioners in County Sligo. Educational sessions were held for both doctors and nurses in SGH. The audit cycle was completed by a re-audit of benzodiazepine and Z-drug prescribing six months from original study using identical methods.

Results: We found a high prevalence of benzodiazepine and Z-drug use in original audit, 54% (38/70) of the group audited. The prevalence fell to 46% (32/70) at the re-audit post intervention. This result was not statistically significant. The percentage of patients commenced on benzodiazepine and Z-drugs prior to admission fell from 36% (25/70) at the initial audit to 23% (16/70) at the re-audit.

Conclusion: Prescribing practices were not in keeping with consensus guidelines as highlighted by this relatively basic audit cycle. Multidisciplinary feedback and letters to GPs resulted in some reduction in the number of patients prescribed benzodiazepines and Z-drugs. Ongoing educational strategies aimed at relevant health care workers with regular audit of medication use within the general hospital setting is pertinent to further improve prescribing practice.
Preferences of dress and address: views of attendees and mental health professionals of the psychiatric services
Authors: Sim Christina , Hallahan Brian , McDonald Colm
Published: March 2016

Objectives: The aim of this study was to determine the views of both individuals attending the mental health services (attendees) and mental health professionals in relation to how attendees and staff should be addressed, how attendees should be described, and how staff should be attired.

Methods: We surveyed 132 attendees of the West Galway Mental Health Services and 97 mental health professionals in relation to how they prefer to be addressed (first name/ title and surname/ no preference) the description of attendees (patient / client / service user / no preference) and the attire of mental health staff (casual / smart / no preference). We also ascertained how mental health professionals believed attendees would view these issues.

Results: Attendees preferred to be described as patients rather than clients or service users by all mental health professionals, with 46-54% of attendees preferring this term “patient” compared to 14-17% preferring the term “client”, 11-13% preferring the term “service user” and 20-25% having no preference (p < 0.001). They preferred to address doctors by their title and surname (61%) but other mental health professionals by their first names (60-69%) (p < 0.001). Attendees had a strong preference for being addressed by their first names by all the mental health professionals (86-91%) (p < 0.001). Doctors preferred to be attired formally (88%), compared to nurses (50%) or other mental health professionals (42%) (p = 0.002). Attendees had no preference in relation to the attire of doctors but preferred other mental health professionals to be attired informally.

Conclusions: The study demonstrates that despite the increased use of several non-medical terms to describe attendees of mental health services; the preferred term of attendees of the psychiatric services in both in-patient and out-patient settings remains ‘patient’. However, this is not universally the case, and the ascertainment of the preference of the attendee at the first encounter with the health professional should be ascertained. We also demonstrated that attendees preferences in relation to both “dress and address” of doctors is significantly different to their preference for nurses or other allied mental health professionals; which may reflect a wish for a less familiar and more formal interaction with doctors.
Psychotherapy training in Ireland: A survey of college tutors
Authors: Lee Alyson , Noonan Angela
Published: March 2016

Objectives: Psychotherapeutic skills are essential to practice psychiatry effectively, but previous surveys of trainees in Ireland show that they have not been getting adequate training in psychotherapy. This survey of college tutors was carried out to coincide with the establishment of the College of Psychiatry of Ireland which is introducing new psychotherapy training requirements. The survey aims to ascertain if trainees had fulfilled the Royal College of Psychiatrists' psychotherapy training requirements, models of psychotherapy available and the availability of psychotherapy qualifications amongst consultants and senior registrars.

Methods: A questionnaire was posted to all registered tutors in the Republic of Ireland.

Results: The postal questionnaire was sent to the 62 registered college tutors in the 13 training schemes. There is one tutor in each training hospital. The response rate was 79%. Our survey reveals that no psychotherapy training was available according to 16.3% of tutors. Only 22.5% of tutors were aware of trainees who had met college training requirements in the previous two years. 79.8% of tutors reported that there were consultants and senior registrars with qualifications in psychotherapy who could offer training if time and resources permitted.

Conclusions: Current training requirements are not being fulfilled. There are consultants and senior registrars who have psychotherapy qualifications to provide psychotherapy training but there are inadequate resources and time to formalise training. It is unlikely that the implementation of training requirements by the new college will be realisable without a review of training delivery.
Suicide ideation, psychological adjustment and mental health service support: A screening study in an Irish secondary school sample
Authors: Brennan Ciara , McGilloway Sinéad
Published: March 2016

Objective: The aim of this exploratory study was to investigate the extent of suicide ideation, psychological maladjustment and views of mental health service support in a sample of secondary school pupils.

Method: A cross-sectional survey was conducted on a purposive sample of participants (n=93) recruited from a secondary school located in the south east of Ireland. Participants completed a Background Information Questionnaire (BIQ); the Suicide Ideation Questionnaire (SIQ); and the Reynolds Adolescence Adjustment Screening Inventory (RAASI).

Results: Approximately ten percent of participants displayed high levels of suicide ideation whilst one third reported having previously had suicidal thoughts; one quarter reported psychological adjustment difficulties, although these varied by age and sex. Participants' drug use and their levels of parental closeness were both individual factors that significantly predicted both suicide ideation and psychological adjustment. Females reported higher levels of parental closeness than males. Forty percent of respondents rated mental health support services as insufficient to meet their needs.

Conclusion: The findings raise serious concerns about the extent of suicidal thoughts amongst young people in Ireland; they also highlight a potentially important role for parents in this regard. Further research should ascertain national prevalence rates whilst appropriate school-based mental health education/promotion and support services should also be implemented.
Melodic dialects in Old Hispanic chant
Authors: HORNBY EMMA , MALOY REBECCA
Published: March 2016

Aside from Don Randel's study of the responsory verse tones, there have been few comparative analyses of Old Hispanic chant melodies. Such comparison requires new methods because of the paucity of surviving manuscripts, the limited sharing of repertoire between them and the nature of the notation. This article examines variants in specific opening and cadential contexts, across the Old Hispanic corpus. In these contexts, cantors chose from a system of interchangeable melodic shapes, which vary by manuscript. Some manuscripts cluster in their choices of these shapes, in ways that confirm Randel's findings, with four melodic dialects in evidence (‘Leon’, ‘Rioja’, ‘Toledo A’ and ‘Toledo B’). Other manuscripts, however, do not fit securely into any of these four dialects, instead showing a certain degree of permeability between the dialects. Although the types of variants we have identified, including differences in notation and melody, may appear ‘insignificant’ in comparisons of individual chants, they emerge as significant markers of melodic dialects in comparisons of large data sets.