bluuebunny/crossref_metadata_2025 huggingface dataset:
Benzodiazepine misuse and dependence among opiate addicts in treatment
Authors: Williams Hugh , Oyefeso A , Ghodse AH
Published: March 2016

Objective: Benzodiazepine misuse among opiate addicts is well described but few studies have reported on the occurrence and management of benzodiazepine dependence within this group. This study reports on the nature and extent of benzodiazepine dependence among a group of opiate addicts and describes the patients' treatment progress and requirement for substitute medication.

Method: Over a 12 month period routinely collected data on all admissions of opiate addicts to our inpatient treatment and research unit were searched. Specific details were then extracted for those 61 admissions who were opiate dependent and also currently misusing benzodiazepines.

Results: 26 (43%) of the 61 admissions were found to bephysically dependent on benzodiazepines. Temazepam and diazepam (respectively) were the most commonly misused preparations and 22% of those using temazepam were injecting it. Patients requiring detoxification were stabilised on doses of diazepam ranging from 20mg to 80mg daily (mean; 40mg). No correlation was found between reported use of benzodiazepines and the dose of diazepam required for stabilisation. Users found to be physically dependent on benzodiazepines more commonly reported daily use and use of two or more benzodiazepines concurrently.

Conclusions: Our findings suggest: 1) that benzodiazepine dependence occurs in opiate addicts with a frequency similar to that reported previously for other groups of benzodiazepine users; 2) that individuals using benzodiazepines on a daily basis may be more at risk of developing physical dependence; and 3) that clinically it is difficult to accurately predict requirements for substitute medication solely from patient's reported daily use prior to admission.
Effects of co-existent cerebrovascular disease on rate of progression in Alzheimer's disease
Authors: Swanwick Gregory RJ , Kirby Michael , Coen Robert F , Maguire Conor P , O'Neill Desmond , Walsh Bernard J , Coakley Davis , Lawlor Brian A
Published: March 2016

Objective: The aim of this study was to determine whether patients with possible Alzheimer's disease (AD) who do not meet criteria for vascular dementia but who nonetheless have clinical or radiographic evidence of cerebrovascular disease (CVD), differ in presentation or rate of progression from patients with probable AD.

Method: Baseline cognitive and functional scores were obtained from 154 patients who had either possible or probable AD. Repeat data after a 12 month interval were obtained on 73 of these patients. Baseline data and rates of progression were compared for probable AD patients and possible AD patients with evidence of co-existent CVD.

Results: The diagnostic groups did not differ at baseline with a mean mini-mental state examination (MMSE) score of 18.1. Comparison of the longitudinal data showed a mean annual drop of 4.1 points on the MMSE in both groups.

Conclusions: The patients with and without evidence of co-existent CVD did not differ either at baseline or prognostically suggesting that evidence of CVD does not affect the rate of progression in AD. However, further longitudinal studies using neuropathological criteria are warranted to determine whether such data can be interpreted in favour of including possible AD cases in clinical trials of probable AD.
Depressive episodes in adults with learning disabilities
Authors: Cooper Sally-Ann , Collacott Richard A
Published: March 2016

Objective:In view of the Royal College of Psychiatrists Defeat Depression campaign, to review the existing literature on depressive episodes in people with learning disabilities.

Methods:Review of all papers identified to cover this area. Papers were identified by Medline search and also by direct checking of the contents in the preceding five years of eight key learning disabilities journals, the British Journal of Psychiatry, Psychiatric Bulletin and bibliography in Current Opinions in Psychiatry. Papers about children or odd ‘depressive’ symptoms (rather than the syndrome of depression) were excluded.

Findings:For over a century it has been recognised that depression can occur in people with learning disabilities. However, the number of studies in this area is very limited. There remain many unanswered questions, such as those of prevalence, clinical presentation and diagnostic criteria, associated social factors, and the evaluation of treatments. Suitable rating scales have yet to be evaluated or devised. The authors propose diagnostic criteria for future use.

Conclusions:Research in this important area is very limited. Advances are yet to be made in the clinical assessment and management of the illness.
Psychosis among the Mayan people of Mexico
Authors: Gibbons Pat
Published: March 2016

The Mayan people of Mexico have a radically different concept of illness than that of western countries. In the absence of any formal psychiatric service in their area, the people continue to rely on the interventions of the traditional healers, which include the use of herbal medicines, prayers and magico-religious rituals. A case history of a Mayan patient with a chronic psychotic illness is described, which illustrates the gulf in concepts of mental illness that exists between Western and folk cultures. These cultural differences may have a profound impact on the application of modern psychiatric interventions in developing countries.
Current research issues in cross-cultural psychiatry
Authors: Gibbons Pat
Published: March 2016

The international pilot study of schizophrenia (IPSS) was the first major study to show that the use of standardised assessment and classification instruments allows the reliable comparison of data on the prevalence, psychopathology and prognosis of major psychiatric illness between different cultures. Important questions about the methodology used in cross-cultural research remain to be answered, however These include the inherently ‘Eurocentric’ nature of much of western psychiatric terminology and the absence of directly comparable concepts and language to describe emotional and psychological distress between western and non-western cultures. These difficulties especially arise in relation to illness where organic factors appear to contribute little to aetiology, such as the neurotic and Axis II disorders, and need to be overcome before useful crosscultural research into these disorders can be accomplished.
Attitudes of general practitioners to child psychiatry services
Authors: McNicholas Fiona
Published: March 2016

Objective: To ascertain the views of Irish GPs with regard to local child psychiatry provision.

Method: 180 randomly selected general practitioners were sent a questionnaire designed to ascertain their views on child psychiatry services. They were asked to rate service provisions, professional staff and therapies offered in terms of priority.

Results: 74 (41%) returned completed questionnaires. Written reports, short waiting list times and emergency inpatient provisions were accorded the highest priority by the largest number of GPs (77%, 64.9%, and 63.5% respectively). Expertise in child sexual abuse, mental handicap and alcohol/drug addiction were also prioritised (77%, 66.2%, & 58.1% respectively). The core staffing required included child psychiatrists, community psychiatry nurses, psychologists and social workers. Family therapy followed by counselling were the most popular treatment modalities. However, more than two thirds (68.6%) of the sample rated their current service as unsatisfactory.

Conclusion: In planning service provision it is important to take into account the needs of the community, referrers' views and accessibility in order to provide optimum services for both users and referrers.
The relationship between menstruation and psychiatric admissions
Authors: O'Dwyer Jane , Friedman Trevor , Clifford Elizabeth
Published: March 2016

Objective: To determine whether the previously reported relationship between menstruation and emergency psychiatric admissions still pertains.

Method: All females admitted on an emergency basis to a general psychiatric unit of a DGH, were interviewed and data regarding menstrual function was collected on those fitting the inclusion criteria who consented to inclusion in the study.

Results: Ninety three people were included in the study, of whom significantly more were admitted in the late luteal and menstrual phases of the cycle. Symptoms suggestive of premenstrual syndrome were significantly commoner in those admitted in the late luteal and menstrual phases.

Conclusions: The findings suggest that the premenstrual syndrome is either a risk factor for psychiatric admission or is important in determining the time of admission. Adequate detection and treatment of premenstrual syndrome, could in theory, reduce some psychiatric admissions. The methodology and limitations of the study are discussed.
Effects of waiting time on appointment attendance with clinical psychologists and length of treatment
Authors: Loumidis Konstantinos S , Shropshire Julia M
Published: March 2016

Objective:With the increasing demand for clinical psychology services and the existing shortage of clinical psychologists, it is theoretically and clinically important to identify variables associated with non-attendance for clinical psychology appointments. The study reported here attempted to: (a) examine the effect of waiting time for an appointment on non-attendance to clinical psychology services; (b) investigate variables associated with prolonged waiting time; (c) explore the nature of the relationship between waiting time and length of psychological treatment.

Method:The records of 49 3 patients offered an appointment to attend a clinical psychology service over a period of 24 months were analysed. Subsequently information on sex, age, type of referring problem, previous treatment history, treatment venue and waiting time for appointment, was collected and statistically analysed.

Results:Non-attendance was significantly related to prolonged waiting time and young age. Controlling for the effects of waiting time and age, patients with complex problems and new patients wh o had never sought psychological treatment in the past were less likely to attend. Length of waiting time was higher in groups with previous treatment history, patients seen at a hospital based department, and patients with complex problems and anxiety disorders. Finally, length of psychological treatment (total number of sessions required) was not affected by prolonged waiting time.

Conclusion:Non-attendance for clinical psychology appointments was associated with (a) young age, (b) prolonged waiting time (over six months), (c) complex psychological problems, and (d) new patients. The limitations and clinical implications of these findings are critically discussed.
An evaluation of Threshold therapeutic communities in Northern Ireland
Authors: Kapur R , Weir MB , McKevitt C , Devine M , Collins L , Maxwell H , Heaney C
Published: March 2016

Objective: To measure the effects of providing a therapeutic community environment for patients suffering from severe mental illness.

Method: 35 patients who remained in a therapeutic community environment for a minimum of 18 months were administered three instruments which measured psychiatric symptomatology (Brief Psychiatric Rating Scale), intrapsychic and interpersonal functioning (Therapeutic Community Questionnaire) and overall psychiatric and psychological functioning (Global Assessment Scale). Assessments were carried out at zero and 18 months.

Results: The Brief Psychiatric Rating Scale revealed significant positive changes on the two items of blunted affect and un-cooperativeness while the global assessment scale revealed that patients significantly improved after 18 months.

Conclusion: Patients who remained in a therapeutic community environment for 18 months demonstrated benefits on three particular variables. While no causative link can be proposed in this study, it does seem that this environment does improve the functioning of severely mentally ill patients.
Risperidone therapy in the control of behavioural disturbances in patients with learning disability
Authors: Natarajan Dhanapal , Martin Alberto Jarabo , Tesh Dorothy
Published: March 2016

Objective: The objective of this audit to examine the effect of risperidone therapy in controlling some behavioural disturbances in people with learning disability.

Method: Retrospective analysis of various behavioural disturbances before and after beginning risperidone therapy (during the month before risperidone was started in each case, and during September 1994 in all cases).

Results: Risperidone was found to be effective in controlling various behaviour problems in 12 of 17 patients.

Conclusion: Risperidone may selectively influence behaviour problems secondary to possible underlying mental illness but not others. There was also some evidence that it was more effective in an average dose of 6-8mg/day, but was not beneficial in doses smaller or larger than this dose range.
Parkinson's disease exacerbated by paroxetine
Authors: Mannion Laura , O'Sullivan Sheila , Carney PA , Moran John
Published: March 2016

Patients with Parkinson's disease are frequently treated by psychiatrists. We report on the exacerbation of parkinsonian symptoms in tw o patients prescribed paroxetine, an SSRI antidepressant. We discuss the possible mechanism for such an interaction.
Hopelessness and suicidal feelings among the community dwelling elderly in Dublin
Authors: Kirby Michael , Bruce Irene , Coakley Davis , Radic Alicja , Lawlor Brian A
Published: March 2016

Objective:The aim of this study was to determine the one-month frequency of hopelessness and suicidal feelings in a community dwelling elderly sample in Dublin.

Method:A total of 891 individuals of 65 years and over, without a dementia, were interviewed using the Geriatric Mental State (GMS)-AGECAT system. Items from the GMS relating to reports of hopelessness and suicidal feelings over the previous month were identified and the relationship of these items to gender and age was studied.

Result:Serious suicidal feelings were rare with 0.2% of the sample expressing a pervasive wish to die, but less intense feelings were more common with 15.5% reporting that life was not worth living. Hopelessness and suicidal feelings were present with similar gender frequencies unlike other studies which have demonstrated a higher frequency among females. Any feeling of hopelessness or suicidality was present in 18.4% of those aged 65-74 years (‘young elderly’) compared with 14.8% of those over 75 years (‘old elderly’). Depressed elderly who reported hopelessness or suicidal feelings were not more likely to be taking antidepressants than the depressives without such feelings.

Conclusion:Cultural factors may explain the pattern of suicidal feelings reported in our sample, with the more intense feelings being rare, and may influence the gender distribution. Hopelessness and suicidality is not more common in the ‘old elderly’ than in the ‘young elderly’ and should not be regarded as an integral part of ageing. The small number of elderly depressives with feelings of hopelessness or suicidality wh o are being treated with antidepressants is a cause for concern.
Platelet studies in panic disorder: A review
Authors: Mannion Laura , Nugent Desmond , Leonard Brian
Published: March 2016

Objective: The blood platelet has been proposed as a model of central neurons and may therefore be used as a peripheral marker of psychiatric illness. One method of investigating serotonin function in panic disorder has relied on the use of the platelet as a model of serotonergic neurons. This article reviews the studies of platelet function in panic disorder.

Method: A literature search and review of relevant papers was undertaken.

Result: Studies examining platelet serotonin uptake and concentration in panic disorder patients have to date yielded conflicting results, with some investigators reporting increased serotonin uptake, others reduced uptake. Similarly studies of platelet 3H-imipramine binding have also yielded conflicting results. Two studies of platelet 3H-paroxetine binding have shown a reduction in the density of binding sites (Bmax) in patients with panic disorder. Platelet monoamine oxidase activity in anxiety disorders has been reported to be increased by some investigators but decreased by others. Methodological considerations may have been responsible for these differences. Finally, studies of α2 adrenoceptor density have also produced contrasting findings.

Conclusion: The findings of these studies indicate that platelet function is altered in panic disorder. Such changes may allow an insight into the biochemical aetiology of the illness. Further studies are required to delineate the role of serotonin and non-adrenaline in panic disorder.
Suicide as altruism: A Darwinian perspective
Authors: Abed Riadh T
Published: March 2016

There has been increased interest recently in the implications of Darwinian theory on psychology, psychiatry and in medicine generally. As a result a large number of publications have appeared that attempt to reformulate a range of psychiatric disorders in the light of evolutionary theory. However, relatively little attention has been paid to the subject of suicide from the evolutionary perspective with some notable exceptions. The purpose of this brief paper is to bring the Darwinian perspective to the notice of a wider psychiatric readership hoping that this will add a further dimension to the debate on suicide and selfdestructive behaviour. Darwinia n theory had found it difficult to account for the existence of altruistic behavioural strategies in social animals until it was explained by Hamilton that the focus for selection was not the individual but the gene. Altruism here refers to any behaviour that reduces the reproductive fitness of the donor while increasing the reproductive fitness of the recipient. According to Hamilton's formulation (the kin selection theory) the individual will behave in a nepotistic manner (ie. altruistically towards kin) as this will enhance the overall chances of his genes to pass to the next generation not only through his own descendants but through non-descendant kin, a measure he termed ‘inclusive fitness’. Therefore it would not be surprising that individuals would be more likely to behave altruistically towards kin than non-kin.
Assaults on psychiatrists – a three year retrospective study
Authors: O'Sullivan Martin , Meagher David
Published: March 2016

Objectives: This study investigates the problem of assaults on psychiatrists by their patients.

Method: A postal questionnaire was circulated to 178 psychiatrists and trainees working in the Dublin area enquiring about assaults experienced in the previous three years.

Results: Of those 147 (82%) who responded 57 (39%) had been assaulted. There were few discriminating factors between those assaulted and those not but those in child psychiatry were less likely and those in general adult psychiatry were more likely to have been the victim of an assault. Only 10% of respondents had received any formal training in violence management. Assailants tended to be male (63%) and known to the doctor involved (71%). Personality disorder (37%), schizophrenia (29%) and substance abuse (26%) were common assailant diagnoses. Management responses to the assaults were generally internal with administrative staff involvement in only four cases.

Conclusions: Factors which potentially protect or expose clinicians to a greater risk of assault are not well defined and need to be further explored. Simple clinician or patient variables are not especially predictive of violence risk. Clinicians need to acquaint themselves better with the basic practices of violence prevention and management. External measures (such as involving administration) could be used more frequently to combat this common problem.
An audit of the care of 266 patients with schizophrenia in 16 general practices
Authors: Holden John
Published: March 2016

Sixteen general practices completed an audit of the care of their patients with schizophrenia. This resulted in improved levels of recording of six different aspects of patient care; family care, Mental State Examination, quality of life, preventive physical care, co-ordinated care and details of medication.
Pharmacogenetics of the hepatic cytochrome P450 enzyme system: its relevance for prescribing in psychiatry
Authors: O'Donohoe Alan , Gill Michael
Published: March 2016

This article reviews the current knowledge regarding the hepatic cytochrome P450 system, with particular reference to its effect on psychotherapeutic medication. The metabolic processes – by which drugs are broken down in the liver by cytochrome P450 enzymes – are affected by genetic variation between individuals, inhibition and induction of these enzymes by other drugs, disease and age. Genetic influences and enzyme inhibition/induction are discussed in particular detail in this article.
Nalbuphine dependence: a brief report from the UK
Authors: Williams Hugh , Remedios Andrew , Rooney Jan , Hanstock Rick
Published: March 2016

Objectives: Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects.

Method: Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service.

Results: There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification.

Conclusions: Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.
Secondary mania following cerebral hypoxia
Authors: Sullivan Gary , Jenkins Peter L
Published: March 2016

A case of secondary mania subsequent to cerebral hypoxia is presented. The relevant literature is briefly reviewed. The authors suggest that cerebral hypoxia be added to the list of causes of secondary mania.
A comparison of voluntary and involuntary patients admitted to hospital
Authors: Rooney Siobhan , Murphy Kieran C , Mulvaney Fiona , O'Callaghan Eadbhard , Larkin Conall
Published: March 2016

Objectives: In view of the apparent public discontent that has been expressed by individuals towards temporary certification and involuntary treatment, this study was set up to assess patients' reactions to their involuntary admission. The study compared the demographic characteristics of voluntary and involuntary patients and assessed their attitudes towards and knowledge of the certification process that presently exists in Ireland.

Method: A total of 68 patients, 38 involuntary patients consecutively admitted over a six month period and 30 voluntary patients selected over the same period, were interviewed with a standard questionnaire, on average six months after discharge.

Results: Involuntary patients were more likely to be single, live with their families and showed no demonstrable gender bias. Involuntary patients had limited knowledge of specific aspects of their individual certifications, particularly with regard to knowledge of their rights, admission status and knowledge of the identity of the applicant of the certificate. Of these, 10% were aware of their rights on admission and only 14% could recall that their rights had been explained to them on admission.

Conclusion: Although patients initially expressed strong feelings of anger on admission towards committal, these feelings were found to reduce over time. Recommendations for improving the present Mental Health Act were suggested by those interviewed and these included a need for an initial assessment period before certification is completed and a need for improved communication by medical staff regarding information on the admission status, the identity of the applicant and on the person's rights.
Schizophrenia, lung cancer and glutathione-S-transferase-μ
Authors: Murphy Kieran C , Graham M , Mantle T , Shelley RK
Published: March 2016

Objectives:Several reports have suggested that, despite the high prevalence of cigarette smoking, the incidence of lung cancer is lower than would be expected in patients with schizophrenia. In addition, patients with lung cancer have been shown to have a lower expression of glutathione-Stransferase-μ (GST-μ) compared to healthy controls. In this study, we tested the hypothesis that GST-μ was a trait marker that protected patients with schizophrenia from developing lung cancer.

Methods:One hundred patients who fulfilled DSMIIIR criteria for schizophrenia were examined for the presence or absence of GST-μ.

Results:Significantly more male (86%) and female patients (64%) were smokers compared to general population rates of 30% and 30% respectively (p < 0.0001). There were no significant differences in the expression of GST-μ in patients (48%) compared to controls (46%).

Conclusions:We found no difference in the expression of GST-μ in patients with schizophrenia compared to normal controls. It is therefore unlikely that GST-μ acts as a trait marker protecting patients with schizophrenia from lung cancer. However, a significantly large smoking prevalence rate was ascertained in the patient population.
Controlled assessment of alcoholics admitted involuntarily to a general psychiatric hospital
Authors: O'Loughlin Fionnula , Webb Marcus
Published: March 2016

Objective:As the provision for the involuntary admission to hospital of alcoholics is likely to be discarded in a new Irish Mental Health Act, the characteristics of patients committed under the 1945 Irish Mental Treatment Act were explored and compared with those alcoholics admitted voluntarily.

Method:All alcoholics admitted compulsorily from 1989-1992 to a general psychiatrichospital in Dublin were compared retrospectively with voluntarily admitted alcoholics. Data was taken from case notes.

Results:Results showed that patients admitted compulsorily were older (t = 3.74, df = 62, p < 0.001) and had more physical complications (X2= 8.4, df = 1, p < 0.004) than those admitted voluntarily. Although results did not reach a statistically significant level, there were proportionately more females in the compulsorily admitted group compared with the voluntary group. The outcome of admission overall was better in those admitted voluntarily, although this was influenced both by length of stay and previous admissions for treatment of alcohol dependence. One particularly interesting finding, regardless of admission category, was that duration of admission was statistically significantly longer for women when compared with men.

Conclusions:Compulsory admission of alcoholics to a psychiatric hospital for very brief periods was not shown to be strikingly helpful, but this study cannot decide whether or not longer periods of compulsory admission would be valuable.
Suicide in Kerry: a comparison of the official and a clinically based rate
Authors: Naughton Mary , Doyle Anne , Melia Patrick , Barry Don
Published: March 2016

The suicide rate for county Kerry in 1988 was determined by clinical means using postmortem records as a starting point. Sixteen deaths due to suicide were thus identified (eight males and eight females). The official figure for the year is 19 (13 males and six females). Four of the clinically determined suicides did not appear in the official figures. Combining information from both sources gives a figure of 23 suicide deaths, a rate of 18.58 per 100,000. The authors conclude that there are continuing deficiencies in suicide recording practices.
Hyponatraemia in elderly and adult psychiatric inpatients
Authors: Critchlow Stephen
Published: March 2016

Objectives: The objectives of this paper are to review the presentation of hyponatraemia and diagnose its cause in psychiatric inpatients.

Method: Episodes of significant hyponatraemia (sodium <130mmol/L) were identified from computerised biochemical data and a retrospective review of patients' notes was carried out.

Result. The diagnoses of hyponatraemia reached were different for the two groups of patients studied, adults of over 65 years and under 65 years. Carbamazepine, polydipsia and medical conditions were found as causes in the below 65 age group. Diuretics, medical conditions and lofepramine were identified as causes in the over 65 age group. Inpatients with polydipsia below the age of 65 had lower sodium (p = 0.013) and urea levels (p = 0.00059) than other groups and patients with carbamazepine induced hyponatraemia tended to have episodic hypocalcaemia (p = 0.056). These groups were compared using Fisher's exact test. This study also showed the overall frequency of serum sodium of less than 135mmol/L to be 9.5% in psychiatric inpatients.

Conclusion: Hyponatraemia is a not uncommon finding in psychiatric inpatients. Attention to drug therapy and biochemical findings are helpful in its diagnosis. Accurate diagnosis is usually possible and may vary according to age-group.
Behaviour disorders in adults with learning disabilities: Effect of age and differentiation from other psychiatric disorders
Authors: Cooper Sally-Ann
Published: March 2016

Objective: To clarify the effect of age on behaviour disorders in adults with learning disabilities, and the differentiation of behaviour disorders from other psychiatric disorders.

Method: Detailed assessments, measuring maladaptive behaviours, psychiatric disorders and demographic factors were completed on 93.7% of all people with learning disabilities aged 65 years and over, living in Leicestershire, UK (n = 134), and also a random sample of adults with learning disabilities aged 20-64 years (n = 73). Behaviour disorders were distinguished from other psychiatric disorders. Descriptive and inferential statistics were calculated.

Result: Equal rates (15%) and types of behaviour disorder were found in the two groups. The presence of behaviour disorder was associated with the severity of learning disabilities, but age was not associated, and nor was presence of epilepsy or gender. In many cases, positive scores on the behavioural assessment, which carers attributed to challenging behaviour/ behaviour disorder, were actually symptoms of psychiatric illness.

Conclusion: Behaviour disorders persist into old age, and therefore require management from the appropriate services. This need will increase, due to increasing lifespan. The accurate interpretation of behaviour scales requires that a comprehensive psychiatric assessment is also undertaken, particularly in elderly people where rates of psychiatric disorders are higher than for younger adults.
Normal ageing and the brain
Authors: Breathnach CS
Published: March 2016

Interest in the psychiatric aspects of old age predated the institution of geriatrics as a clinical discipline, but the systematic study of the ageing brain only began in the second half of this century when an ageing population presented a global numerical challenge to society. In the senescent cerebral cortex, though the number of neurons is not reduced, cell shrinkage results in synaptic impoverishment with consequent cognitive impairment. Recent advances in imaging techniques, combined with burgeoning knowledge of neurobiological structure and function, have increased our understanding of the ageing processes in the human brain and permit an optimistic approach in the application of the newer insights into neuropsychology and geriatric psychiatry.
Behavioural management of Prader-Willi syndrome
Authors: Gibbons Pat , O'Donoghue Kathryn
Published: March 2016

Prader-Willi syndrome is a genetic illness associated with a defect on chromosome 15. It presents with hypotonicity in infancy followed by voracious appetite and gross obesity from early childhood and with a range of other clinical and behavioural sequelae. This case report is of an adolescent boy who was admitted to a psychiatric unit for an intensive behavioural programme to control his weight gain and deal with associated behavioural problems, and demonstrates that an inpatient programme can lead to sustainable improvements in weight control and other indicators of well-being in PWS patients.
Sexual abuse in childhood and subsequent illicit drug abuse in adolescence and early adulthood
Authors: Browne Roy , Keating Shay , O'Connor John J
Published: March 2016

Objectives: This study examines the frequency of childhood sexual abuse and physical abuse in a cohort of opiate addicted patients and looks at clinical correlates in those abused.

Method: Fifty-two consecutive patients attending an out patient drug treatment programme were interviewed using a semi-structured technique. Demographic details, details of schooling, marital status and number of children were recorded. The duration of drug abuse, age of onset of opiate abuse, early life experiences of both child sex abuse and childhood violence and a family history of alcohol abuse were also investigated.

Results: 21.2% of patients gave a history of sex abuse, with 23.1% of patients having a history of exposure to violence as a child. Those exposed to sex abuse had an earlier age of onset of opiate injection. A correlation between parental alcohol abuse and sex abuse and violence was noted.

Conclusions: A history of child sex abuse was associated with earlier onset of opiate abuse in this group of patients. The relatively frequent incidence of abuse and violence in those with opiate abuse must be born in mind when providing treatment. The addressing of issues relating only to addiction leaves earlier traumas continuing to exert an influence on the patient.
Mental illness in an elderly rural population in Ireland: a prevalence study
Authors: Kelleher Margaret , O'Sullivan Mary , McMahon Nuala
Published: March 2016

Objectives: The aim of this study was to provide the first Irish prevalence data on mental illness in an elderly, rural, community dwelling population.

Method: Subjects were identified from four general practitioners' lists. This included GMS patients, private patients and nursing home residents. Six hundred and fifty people aged 65 years or over were interviewed in their own homes using GMS-AGECAT, a standardised diagnostic instrument.

Results: The overall prevalence of mental illness was 14.6%. The prevalence of depression was 9.4%. There was a significantly higher rate among women (13.2%) than men (4.3%). Depression in women was not age related. Of the total sample, 3.7% were classified as organic cases. Of the remaining cases, anxiety disorders occurred most frequently and represented 0.9% of all cases.

Conclusions: Elderly people in rural areas experience similar levels of psychiatric morbidity as those in urban centres.
Adolescent parasuicide in the Foyle area
Authors: Davies Mark , Cunningham Gerry
Published: March 2016

Objectives: Renewed scientific and media interest in suicidal behaviour has resulted in a number of initiatives examining and defining this complex and tragic phenomenon. However, in comparison to the study of adult suicidal behaviour, that of adolescents is still under researched. This study aimed to identify the extent and nature of parasuicide in young people under 17 years of age in the Foyle area in the 28 month period up to and including April 1997.

Method: The psychiatric assessments of all those admitted to hospital as the result of parasuicide during this period were examined. A psychosocial and clinical profile of this group of young people was then constructed. Any reported stressors recorded in the assessments were noted, and an attempt was made to ‘track’ contact with helping agencies in each case during the months immediately before and after admission.

Results: One hundred and twenty four young people were admitted during the period under review, the vast majority following an overdose.

Conclusions: Family conflict, family illness and bullying were the three most frequently recorded stressors. Twothirds had no apparent contact with services in the three months prior to admission, and of these, half were not referred on to specialist services after they had been discharged from hospital.
Does psychosis predict response to ECT in depressed elderly patients?
Authors: Gormley Niall , Cullen Con , Watters Liam , Philpot Michael , Lawlor Brian A
Published: March 2016

Objectives:To compare the electroconvulsive therapy response of a sample of depressed elderly patients as a function of the presence or absence of psychosis.

Method:Retrospective study of patients over age 65 treated with ECT at three psychiatric hospitals over a three year period.

Results:One hundred and eighty-nine ECT courses were administered to 135 patients. Almost 8 5% of patients made a marked or moderately good response to treatment. There was no difference in ECT response between psychotic and non-psychotic depressed patients.

Conclusions:ECT should be considered as a treatment option for severe depressive illness, regardless of depressive subtype.
Circadian system and sleep anomaly in depression
Authors: Emilien Gérard , Maloteaux Jean-Marie
Published: March 2016

Abnormalities of circadian rhythms in depressed patients have been noted, including decreased amplitude, distorted waveform, day-to-day instability, and unusual 48 hour periods. Consistent electroencephalographic sleep recording in these patients show a shortened rapid eye movement latency and slow-wave sleep (stages 3 and 4), resulting in an increase in rapid eye movement sleep. This phenomenon appears to be a dependable, measurable marker for diagnosing primary depression. Total sleep deprivation appears to significantly improve mood in a high percentage of depressed patients. Current pharmacological research suggests that drug treatment such as lithium would not affect the intra sleep cycles of the REM stagebut would shift the phase backward and lithium would also shift the phase of circadian rhythm of the daytime sleepiness backward. This paper highlights some of the new approaches for investigating the molecular substrate for the control of circadian rhythmicity and sleep in man and critically examines the hypothesis of the alteration of this mechanism in psychopathology, particularly depression. What is known of the endogenous clock mechanism is discussed with known molecular circadian mechanisms with a view towards understanding how circadian information is transmitted to the rest of the central nervous system and how it is affected in depression.
Louis Wain: his life, his art and his mental illness
Authors: McGennis Aidan
Published: March 2016

This year we celebrate the 60th anniversary of the death of that famous cat artist, Louis Wain. It is therefore appropriate to reflect briefly on his life, his art, and in particular the rather controversial nature of his mental illness.

Louis Wain was born in London in 1860, the eldest child of William, a textile traveller, and Felicia, a designer of carpets. Louis had five younger sisters. As a child he was regarded as physically weak, not starting school until the age of 10 where his academic performance was indifferent, and from which he played truant frequently. In 1877 he went to the West London School of Art, qualifying in 1880. His first job was that of an art teacher, but he needed to supplement his income from this job by doing freelance illustrations for magazines. Eventually he gave up art teaching and became a full-time illustrator, working initially with the Illustrated Sporting and Dramatic News.

In 1884 he married Emily Richardson, a governess in the Wain household and 10 years his senior. Their happy marriage ended two years later when Emily died of breast cancer. During her illness a stray black and white kitten joined the Wain household. The kitten was named Peter and he was a great comfort to Emily in her terminal illness. While Louis sat frequently by his wife's sick bed he began drawing Peter from every possible angle. This was the first time he showed any interest in drawing cats, as prior to that he had been a general illustrator.
Making contact – bereavement and Asperger's syndrome
Authors: Marston Geoffrey M , Clarke David
Published: March 2016

A case of abnormal bereavement is described in a man with borderline learning disability and Asperger's syndrome. Bereavement issues and concurrent assessment of psychiatric illness in people with pervasive developmental disorders are discussed. Particular reference is made to relevant psychopathology and possible underlying psychodynamic mechanisms.
The use of clozapine in an individual with moderate intellectual disability, aggressive behaviour and resistant psychosis
Authors: Kamal Manzar , Kelly Mary
Published: March 2016

The case of a 32 year old man with moderate intellectual disability, severe behavioural problems and psychotic symptoms is described. Having tried various traditional antipsychotics he was commenced on clozapine with a marked improvement in symptoms. Clozapine is a useful drug for the treatment of schizophrenia in the intellectually disabled who are refractory to the conventional antipsychotics. It improves aggressive and self-injurious behaviour which may be in addition to its antipsychotic effect.
The utility of naming tests in the diagnosis of Alzheimer's disease
Authors: Coen Robert F , Kidd Nicholas , Denihan Aisling , Cunningham Conal , Bruce Irene , Buggy Fiona , O'Neill Desmond , Walsh J Bernard , Coakley Davis , Lawlor Brian A
Published: March 2016

Objectives: To evaluate the sensitivity of the CAMCOG naming subscale to anomia in Alzheimer's disease (AD) patients identified as anomic on the Boston Naming Test (BNT); and to compare the sensitivities of BNT, category (semantic) fluency (CF), and episodic memory (Delayed Word Recall, DWR) in detecting AD.

Method: Data from 140 probable AD patients (NINCDS/ADRDA) were analysed. Anomic AD patients were identified (BNT) and the sensitivity to anomia of the CAMCOG naming subscale was calculated. Sensitivity (to AD) and specificity of the BNT, CF and DWR were compared in a subgroup of 60 patients age-matched to controls.

Results: On BNT 81% of ADs were classified as anomic (87% specificity). Of these anomic ADs, 23 scored 6/6 on CAMCOG naming (sensitivity = 80%), and sensitivity fell to 30% using a 5/6 cut-off. Correlation between BNT and CAMCOG naming yielded Kendall's tau = 0.48 (p<0.0001). Compared to age-matched controls BNT correctly classified 70% of ADs and 87% of controls (overall accuracy = 77%). On CF 68% of ADs and 83% of controls were correctly classified (overall accuracy = 72%). BNT and CF were moderately correlated (r = 0.49, p<0.0001). DWR correctly classified 93% ADs and 98% controls (overall accuracy = 95%).

Conclusions: Given its brevity, we recommend the inclusion of a split-half form of the BNT in screening test batteries for the detection of AD. The observed pattern of cognitive impairment is consistent with current models in which semantic memory deficits occur in AD only when the neuropathology extends beyond the entorhinal/hippocampal region to the temporal neocortex.
Deliberate self-harm: how feasible are the current guidelines?
Authors: Currie Alan , Blennerhassett Richard
Published: March 2016

Objectives: To examine the operation of a deliberate self-harm service at a large general hospital with reference to standards outlined by the Royal College of Psychiatrists. To examine the characteristics of referrals and to make recommendations for improvements to the service.

Method: Data on referral and assessment characteristics were collected for 96 consecutive referrals over a three month period.

Results: The services achieved the college standards in relation to the time period for assessments. Most referrals were made routinely at a predictable time but assessments were conducted on an ad hoc basis. Only a minority of those referred had a mental illness or complex problems. A significant number of patients were discharged from the A&E department without a psychiatric assessment. Assessors underemphasised the role of previous deliberate self-harm and/or the presence of mental illness in forming a judgment on the risk of suicide. After-care arrangements were predominantly medical (general practitioners or psychiatrists) with little multidisciplinary input.

Conclusions: The deliberate self-harm service at the hospital could be improved by the establishment of a self-harm services planning group to oversee the delivery of the service throughout the hospital and address the deficits identified. Given the number of referrals seen within the service and the fact that deliberate self-harm is only one element of a comprehensive liaison service, consideration should be given to the establishment of a separate multi-disciplinary liaison team. Once again importance is drawn to the need for all assessors to be aware of the risk factors in relation to the future risk of suicide rather than placing undue emphasis on whether the most recent attempt was planned or impulsive in nature.
Doctor Maurice O'Connor Drury, Wittgenstein's pupil
Authors: Wallace John
Published: March 2016

Doctor Maurice O'Connor Drury worked for most of his life in Saint Patrick's Hospital, Dublin. While going about his routine clinical work at that hospital, Doctor Drury quietly maintained a close, lifelong friendship with the man regarded as perhaps the greatest philosopher of the 20th century, Ludwig Wittgenstein.

Few realised that before studying medicine at Trinity College, Dublin, ‘Con’ Drury had read philosophy at Cambridge, where he came into close contact with some of the great minds of philosophy this century; Bertrand Russell, George Moore and Gilbert Ryle.

Con Drury is importan t not just because of his own philosophical work but because, through his enduring friendship with the deeply troubled philosopher, he challenged the portraye d image of Wittgenstein as a ‘cantankerous, arrogant and tormented genius’.
The relationship between karyotype and cognitive functioning in Turner syndrome
Authors: O'Connor John , Fitzgerald Michael , Hoey Hilary
Published: March 2016

Objectives: To examine the underlying cognitive abilities of girls with Turner syndrome, as well as to examine the nature, direction and extent of discrepancies between verbal and performance functioning.

Method: Standard tests of intellectual functions (WISC-R and WAIS-R) were administered to 28 girls with Turner syndrome. Subjects varied in age between one year and nine years.

Results: The findings indicate that there is strong, though not entirely consistent, tendency among Turner subjects to show depressed performance scores in comparison with their verbal scores. There was also a tendency toward lower levels of overall cognitive functioning among girls with the classic karyotype over those with mosaic karyotypes.

Conclusions: These findings are in keeping with international findings concerning the intellectual functioning, of girls with Turner syndrome. The findings support the view that the X chromosome is important in regulating the overall balance within the intellectual functioning between verbal and performance domains.