bluuebunny/crossref_metadata_2025 huggingface dataset:
A 15 month follow-up study of children admitted to a child psychiatric inpatient unit
Authors: Sheerin Declan , Maguire Roseann , Robinson Jean
Published: March 2016

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.

Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.

Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.

Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.
Ganser syndrome – 100 years on
Authors: Williams Kelwyn
Published: March 2016

A patient presenting with psychogenic paralysis then Ganser syndrome is described. Formulation is made in terms of unresolved grief manifesting as shifting dissociative symptoms. Treatment and the patient's resistance to it are discussed. The nosological status of Ganser syndrome 100 years on is reviewed and the role hysteria as a causative mechanism endorsed.
Gender differences in characteristics of drug users presenting to a Dublin syringe exchange
Authors: Geoghegan Tony , O'Shea Mary , Cox Gemma
Published: March 2016

Objectives: This study explores the gender difference in patterns of drug use, risk behaviour, health and well-being among 934 new attenders at a Dublin syringe exchange.

Method: Over the period May 1997 to April 1998 data was collected by means of structured interviews with all clients who presented for the first time at Merchant's Quay health promotion unit. All information collected was based on clients' self-reported behaviour.

Results: Of the new clients, 24.3% were female and 75.7% were male. The female clients were significantly younger than their male counterparts (p < 0.0001). The women were significantly more likely to report having a sexual partner who was an injecting drug user (OR 9.04, 95% CI, 5.9-13.9) and to be living with an injecting drug user (OR 1.69, 95% CI, 1.2-2.3). They were also significantly more likely to share injecting equipment with their sexual partner (OR = 3.83, 95% CI, 2.7-5.5) and to report recently sharing injecting paraphernalia (OR = 1.79, 95% CI, 1.3-2.5). However, the interval between initiating intravenous drug use and first presenting at the Merchant's Quay health promotion unit was significantly shorter for female clients (p < 0.0001).

Conclusions: One of the most important concerns with regard to illicit intravenous drug use is that of needle sharing, and the associated risks of infection with human immunodeficiency virus and hepatitis. This study highlights the greater personal involvement of women with other drug users, and its consequences in terms of healthrelated problems and risk behaviour. There is a need to address this issue, by taking advantage of the fact that women present for treatment at a younger age than their male counterparts and at a much earlier stage in their injecting career.
Differential diagnosis of adolescent and adult pervasive developmental disorders/autism spectrum disorders (PDD/ASD): a not uncommon diagnostic dilemma
Authors: Fitzgerald Michael
Published: March 2016

The failure to recognise the pervasive developmental disorders/autism spectrum disorders is probably not uncommon in adult psychiatry. Indeed some of the treatment-resistant chronic mental illnesses are due to the failure to make this diagnosis and apply more appropriate treatment.

Patients with PDD/ASD cause considerable diagnostic difficulties in both inpatient and outpatient adolescent and adult psychiatry. Clinical experience suggests that patients with PDD/ASD in adulthood have been misdiagnosed as having schizophrenia resulting in inappropriate treatment. Mesibov and Handlan state that the diagnostic situation is complicated because the characteristics of autism are less pronounced in older clients. It is critical that an accurate diagnosis is given because of the specific treatment implications. In the past decade there have been considerable developments in our understanding of autism. The importance of bringing the developmental viewpoint into adult psychiatry is now highly relevant. Unfamiliar diagnostic categories now have to be considered by adolescent and adult psychiatrists. Grounds for the deletion of adult psychiatric disorders, eg. simple schizophrenia from ICD102 may exist. Instead PDD/ASD disorder may need to be considered.

As the purpose of diagnosis is to ensure appropriate client management, it is essential that diagnostic criteria are continually reviewed in view of clinical observation and research developments. In this paper, diagnostic categories causing confusion are outlined, and that these are variants of the core deficit of autism is suggested. The major PDD/ASD diagnoses in adolescence and adulthood are listed below.

Two of the following are required for the diagnosis of autism:
Attitudes to doctors and medicine: a failure to replicate
Authors: Conroy Ronán M , Siriwardena Ruwani , Smyth Olive , McGee Hannah M , Fernandes Paula
Published: March 2016

Objectives: Despite their potential importance in affecting interactions between doctors and patients, there have been few attempts to measure attitudes to doctors and medicine. One scale, developed by Marteau, had shown a promising factor structure in a UK antenatal setting. The present study assessed its characteristics in Dublin general practice attenders.

Method: Patients aged over 16 waiting for a self-initiated consultation were recruited. The Attitudes to Doctors and Medicine Scale was administered by interview. Item analysis and factor analysis were used to examine its psychometric properties.

Results: Of 200 respondents, with a median age of 31, 144 were women. Item analysis showed lower reliabilities for the subscales of Marteau's scale than the original UK study, especially the subscales measuring negative attitudes to doctors and to medicine. Factor analysis failed to confirm a clear-cut distinction between attitudes to doctors and attitudes to medicine, and between positive and negative attitudes. Furthermore, factors which loaded in opposite directions in the original UK study loaded in the same direction in the Irish sample.

Conclusions: The differences found may reflect the differences either in culture or setting between the two studies. They strongly suggest that the Attitudes to Doctors and Medicine Scale does not have desirable psychometric properties. They also underline the need for a reliable and valid measure of attitudes to doctors and medicine, and for a more serious research interest in the area.
Suicide rates in Irish counties
Authors: Connolly John F , Lester David
Published: March 2016

Objectives: This study was designed to explore the social correlates of the country suicide rate in Ireland.

Method: Suicide rates for Irish counties were calculated for the period 1978-1984, a seven year period centred around the 1981 Census.

Results: The county suicide rates were positively associated with death rates and the percentage of elderly population and negatively with change in population, the birth rate and the percentage of the population under the age of 15.

Conclusions: There is good evidence to suggest that the official suicide rate in Ireland has been underestimated in the past. This underestimation may not have been uniform across all of the counties.
A survey of clozapine prescribing for inpatients in a tertiary psychiatric hospital
Authors: Haw Camilla , Stubbs Jean , Mountjoy Christopher
Published: March 2016

Objectives: To audit the prescribing of clozapine for inpatients at a large, specialist psychiatric hospital.

Method: The clinical standards used were agreed by the authors after reference to the clozapine data sheet and British National Formulary (BNF). Prescribing practices for forty-six patients were audited.

Results: In this population of difficult to manage, treatment-resistant schizophrenic patients, prescribing and case note documentation needed improvement. Although almost all of these patients had had an adequate trial of clozapine monotherapy, over a quarter were currently receiving clozapine augmented with another antipsychotic. Plasma clozapine monitoring was used only once in a patient who had failed to respond adequately to clozapine.

Conclusions: Clinicians should fully document the patient's consent to treatment, the clinical response to treatment and the reasons for any deviation in clinical practice from that recommended by the data sheet and national formulary. Plasma clozapine monitoring should be used to optimise therapy and clinical rating scales should be used to evaluate outcome. Until the clinical effectiveness of clozapine augmentation strategies is proven, their use should be restricted to cases where evidence-based therapies have failed.
Substance use history taking by trainee psychiatrists: “There is a tide in the affairs of men…”
Authors: Grandison Alistair , Williams Hugh , Oyefeso Adenekan , Dratcu Luiz
Published: March 2016

Objectives: To investigate the extent and quality of substance use history taking by trainee psychiatrists.

Method: A retrospective clinical casenote audit of admissions to an acute inner city psychiatric unit during three randomly selected months. Data on substance use history taking was recorded by means of a specially designed study checklist.

Results: In almost three-quarters (45, 73%) of admission episodes trainee psychiatrists had made some mention of substance misuse. However, substance use history taking often occurred subsequent to the initial clinical assessment and varied greatly in quality.

Conclusions: The need for a brief, standardised substance use screening questionnaire, easily incorporated into the existing psychiatric interview format is highlighted.
Psychiatric disorders amongst adults with learning disabilities - prevalence and relationship to ability level
Authors: Cooper Sally-Ann , Bailey Nicola M
Published: March 2016

Objectives: To determine the prevalence of psychiatric disorders in adults with learning disabilities, and the relationship with severity of learning disabilities.

Method: The study is population-based. Detailed psychiatric assessments on 207 adults with learning disabilities living in Leicestershire, UK. were conducted by a learning disabilities psychiatrist, using the Present Psychiatric State - Learning Disabilities; and Disability Assessment Schedule. Diagnostic criteria are clearly defined. Developmental assessments were undertaken using the Vineland Scale (survey form).

Results: Psychiatric disorders were found in 49.2%, and rates for most individual disorders were higher than those found in the general population. Comparison with the two previous population-based studies shows the ascertained rates were broadly similar to those reported by Corbett but higher than those reported by Lund. Adults with more severe learning disabilities had higher rates of additional psychiatric disorders.

Conclusions: The results may be explained by a combination of the genetic, physical, psychological and social factors associated with learning disabilities also being aetiological to psychiatric disorders. The high prevalence rates of psychiatric disorders demonstrate the importance of health service provision for adults with learning disabilities.
Psychological problems of early school leavers
Authors: James Deborah , Lawlor Maria
Published: March 2016

Objectives: To establish the prevalence of psychological problems in early school leavers, who attend training schemes.

Method: The Youth self report inventory was completed by teenagers as part of a group setting. Percentages of those scoring above clinical threshold were calculated and gender differences examined.

Results: 78 teenagers participated in the study, 40 males and 38 females. 24% were classified as being in the clinical range of total problem score. Girls reported more total, internalising and externalising problems than boys. 13% of girls frequently thought of suicide and 7% had frequent thoughts of self harm, this contrasts with none of the boys admitting suicidal ideation and 2.5% reporting thoughts of self harm.

Conclusions: 24% of this group experienced problems which placed them within the clinical range. Girls experienced greater problems than boys and appear to be at greater risk of self harm. This group appear to be representative of those who attend training programmes, however it is not possible to determine whether they are representative of all early school leavers. This highlights the vulnerability of older adolescents, and in particular those who leave school early. More detailed examination of issues facing this group are needed and should be a priority along with greater service provision from the educational and health sectors.
Suicidal thoughts and acts in Irish adolescents
Authors: Rowley Jo , Ganter Kathleen , Fitzpatrick Carol
Published: March 2016

Objectives: To determine the frequency of reported suicidal thoughts and acts in (a) a school-based sample of Irish adolescents, (b) adolescents attending a community child and family mental health service.

Method: The study population consisted of: (a) 195 adolescents aged 13-15 years attending ten secondary schools throughout Ireland. The schools were selected to represent a wide social and cultural spread: and (b) 66 adolescents aged 13-15 years attending a community child mental health service. The measures used were the Child Behaviour Checklist completed by the parents of the adolescents and the Youth Self Report completed by the adolescents.

Results: Within the school sample, the parents of 3% of adolescents reported that their child had talked of harming him/herself, but none reported acts of self-harm. Fifteen percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 8% reported that they had tried to harm or kill themselves.

Within the mental health clinic attenders sample, the parents of 33% of the adolescents reported that their child had talked of harming him/herself, and the parents of 27% reported that their child had tried to harm or kill themselves. Twenty-one percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 21% percent reported that they had tried to do so. In both groups, adolescents with higher total problem, internalising and externalising scores on the questionnaires, indicating greater disturbance, were more likely to report thoughts and acts of self harm.

Conclusions: Thoughts of suicide and acts of self harm are common in Irish adolescents and are not limited to those attending mental health services. Parents are frequently unaware of these thoughts. Further studies involving interviews with adolescents at risk are indicated to determine the significance of these thoughts and how adolescents deal with them.
New unit on old ground or general hospital — where do patients want inpatient treatment?
Authors: Lyons Declan , Sayed Onsi Abd El , Matthew VM
Published: March 2016

Objectives: To establish if the relocation of the acute adult psychiatric services of the Dartford area from a district general hospital (DGH) to a new unit in the grounds of Stone House Hospital, the large institution where they were formerly based, increased the stigma of receiving inpatient treatment.

Method: A brief survey of service users asked if this move near to, but not within, the old institution potentially increased the stigma of receiving inpatient treatment.

Results: Inpatients initially welcomed the move but expressed greater concern about stigma and on balance were substantially less enthused than outpatients about the move to a separate psychiatric hospital.

Conclusions: Moving an inpatient unit back to the vicinity of a large institution from a DGH setting is rare, however concerns about consequent stigma, particularly felt by inpatients merits early consideration at planning stages.
Characteristics and treatment of asylum seekers reviewed by psychiatrists in an Irish inner city area
Authors: Kennedy Noel , Jerrard-Dunne Paula , Gill Michael , Webb Marcus
Published: March 2016

Objectives: To assess social and educational status, trauma experienced, diagnosis and treatment of asylum seekers, who presented to psychiatrists in St James's hospital Dublin over a two-year period.

Method: All files of asylum seekers assessed by psychiatrists in St James's hospital over a two-year period were scrutinised. Using a pro-forma, data was obtained about social and educational status, language skills, trauma suffered, diagnosis, treatment and follow-up. Demographic data was obtained from the Department of Justice, the Irish refugee centre and various social welfare offices.

Results: Over a two-year period 31 asylum seekers were in contact with this service. Most originated from Africa. Overall subjects were well educated but socially isolated with poor language skills. Many had been imprisoned or tortured, or had relatives or friends tortured or killed prior to migration. Almost one third met criteria for PTSD and greater than a third met criteria for major depression. The majority of subjects received pharmacological treatment, but few were offered psychological treatments. Most had no prior psychiatric diagnosis and dropped out of treatment at an early stage.

Conclusions: Large numbers of asylum seekers are currently residing in Dublin and may need specialised psychological support and treatment. They have been exposed to significant levels of pre-migratory trauma, often have poor language skills and drop out of treatment quickly which may indicate dissatisfaction with existing treatment approaches. There is an urgent need for increased funding for the psychological needs of this vulnerable group, for the provision of trained interpreters, specialised psychotherapy and assessment of their needs.
Psychiatric services in Ireland: North and South
Authors: Webb Marcus , McClelland Roy , Mock Glenda
Published: March 2016

This overview of mental illness services in Ireland, North and South, over recent decades, is a descriptive account. It refers to policies, development and operation of the services, with certain figures relating to hospital admissions, human resources and costs in Northern Ireland and the Republic of Ireland. The paper points to the need for more detailed comparisons, which would require more rigorous, systematic health services research.
James Joyce and a North Dublin asylum
Authors: Collins Aidan
Published: March 2016

It is perhaps surprising that mental illness has such a limited role in the various works of James Joyce. When one considers the volume of material in his books relating to Dublin, topographical and biographical, there appears to be a studious avoidance of psychiatric institutions. The then huge Grangegorman complex (now St Brendan's Hospital) must have had an ominous presence in the city: the size of its population (between 1,500 and 2,000 patients) indicating that few families of whatever class could have escaped contact with it. Indeed, as an institution it probably had economic power comparable to Guinness's brewery or the British Army, which had five barracks in the city, each about the same size as Grange-gorman.
Mental illness in migrants: diagnostic and therapeutic challenges
Authors: Feeney Larkin , Kelly Brendan D , Whitty Peter , O'Callaghan Eadbhard
Published: March 2016

We describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.
Cognitive psychotherapy: what happens when the therapeutic relationship breaks down?
Authors: Bannan Noreen , Malone Kevin M
Published: March 2016

Behavioural and interpersonal difficulties arising during the course of cognitive psychotherapy are common and they provide unique opportunities to assess and modify patients' beliefs and assumptions. A breakdown in the therapeutic relationship may be on a continuum from a simple misunderstanding to a more chronic and complex problem. It may act as a potent vehicle for change in the patient, but may also precipitate change in the therapist who is also part of that relationship which can influence treatment outcome.
Venlafaxine precipitated visual hallucinations
Authors: Gafoor Rafael A
Published: March 2016

A case of venlafaxine associated visual hallucinations is described. The underlying neurochemical pathophysiology is explored and recommendations for management of patients who experience this side effect are discussed.
What is the profile of post-traumatic reactions within medical literature? A survey of eight journals
Authors: Hull Alastair M , Doherty Patricia M , Bowes Linda J
Published: March 2016

Objectives: The importance of traumatic events is recognised by the public but the profile of psychological sequelae such as Post-traumatic Stress Disorder (PTSD) within psychiatry and medicine is unclear. We aimed to establish the profile of PTSD within high impact medical journals and within psychiatric journals based in America and the United Kingdom, since the initial classification of PTSD in DSM-III in 1980 and, before and after classification of PTSD in ICD-10 in 1992.

Method: A survey of all articles on post-traumatic reactions published in eight journals between 1980 and 2000.

Results: The proportion of articles on PTSD was less in UK based psychiatric journals than their counterparts based in America. The proportion of articles published after the classification of PTSD in ICD-10 has increased in both psychiatric and medical journals.

Conclusions: In UK based journals, there is an under-representation of articles on PTSD compared with disorders of similar prevalence.
Home-based treatment in Monaghan: the first two years
Authors: McCauley MacDara , Rooney Siobhan , Clarke Ciaran , Carey Teresa , Owens John
Published: March 2016

Objectives: To describe a home-based treatment (HBT) service. To profile the patient population using HBT. To determine why HBT was used and to record disposal.

Method: All patients treated by HBT during the first two years of this new service were identified from the HBT logbook. A checklist recording demographic, diagnostic, presenting complaint data and details of HBT contact was used to analyse the patients' charts. A statistical package JMP was used to analyse the data.

Results: Two hundred and six patients (275 episodes) were treated using HBT. These were 101 (49.1 %) males and 105 (50.9%) females. Of these, 89 (43.2%) were single. Forty-eight (19.4%) lived alone and 53 (25.7%) were unemployed. The most common presenting complaint was severe depression (39.3%). A depressive disorder was the most frequent diagnosis (28.7%). Twenty six (13%) episodes of HBT ended in admission. One hundred and eighty five (67.3%) were referred to outpatients and 26 (9.5%) were discharged to the GP.

Conclusions: Home-based treatment is feasible for a wide range of patients with an array of presenting complaints. This model of service delivery is viable in a rural setting. Admission will still be required for some patients. Further work is needed to examine its sustainability and its generalisability to other Irish settings.
Complex partial seizures presenting as frontotemporal dementia: a case report
Authors: Goggins Ray
Published: March 2016

Both epilepsy and dementia are common after the age of 65. Epilepsy, originating in the temporal lobes, can present clinically in a variety of ways and can be difficult to diagnose. Loss of consciousness may not be evident. Reported here is a unique case of a 65 year old man who presented with clinical features of frontotemporal dementia but was subsequently diagnosed as suffering from complex partial seizures. He made a full recovery with antiepileptic treatment.
Meeting the needs of people with schizophrenia living in the community: a report from a European collaboration
Authors: Keogh Fiona , Finnerty Aine , Walshe Anne O'Grady , Daly Ian , Murphy Denis , Lane Abbie , Walsh Dermot
Published: March 2016

Objectives: This study was carried out as part of a collaborative European study, with the aim of assessing needs in a population with chronic schizophrenia in the context of a community service, and also to measure service use in this population.

Method: This is the first part of a 12 month follow-up study of a sample of persons with schizophrenia who were in contact with the psychiatric services. Seventy eight patients who matched the inclusion criteria were randomly selected and 64 (82%) were interviewed using the Schedules for Clinical Assessment in Neuro-Psychiatry (SCAN) and the Needs for Care Assessment Schedule (NCAS). Service use data for a 12 month period were collected prospectively using the Mannheim Service Recording Sheet (MSRS).

Results: The levels of clinical and social need were quite low at 2.1 and 2.6 respectively. Most needs were met; unmet need was 0.11 for clinical problems and 0.4 for social. Service use was high, with a total of 6,969 contacts with community services, a mean of 109 per patient per year. Total service use (including inpatient and hostel) was partly predictive of met need (R2 23.6). The levels of met and unmet need in Dublin compare favourably with that reported in Mannheim and Granada. Service use was similar to that in Mannheim, although there was a higher level of service provision in Mannheim.

Conclusions: This study has shown that there is a low level of clinical and social need in this sample of patients with schizophrenia living in the community, and a relatively high level of service use. There is good evidence that services are meeting the needs of this sample of patients.
Secular trends in the mental health of primary school children
Authors: McArdle Paul , Prosser Jonathan , Dickinson Heather , Kolvin Israel
Published: March 2016

Over the recent past, reports have argued that there has been a decline in the mental health of children and young people in Western societies. This is said to have occurred gradually over the second half of the last century and possibly longer. This view is based on evidence of a progressively declining peak age for adult type depressive disorders, and an apparent increase in adolescent disturbance such as substance abuse, attempted and completed suicide, perhaps eating disorders, and behaviour disorders. These phenomena have been attributed to the major changes in social values and behaviour, with their impact on child rearing and family life that gathered pace over the course of the last century.
Pseudophaeochromocytoma associated with clozapine treatment
Authors: Prasad Sarah E , Kennedy Harry G
Published: March 2016

We describe a 44 year old man with treatment resistant schizophrenia who developed pseudophaeochromocytoma on clozapine with high blood pressure, tachycardia and elevated 24 hour urinary catecholamines. All resolved on discontinuing clozapine. We reviewed the literature and found five other cases. We suggest that this is a common side effect, transient in some patients. Elevated plasma noradrenaline does not appear to be relevant to the unique benefits of clozapine.
Risk factors for violence: an audit on the effect of a tutorial on risk assessment
Authors: Sundrum Frederick , Browne Stephen
Published: March 2016

Objectives: To evaluate the effect of a risk assessment tutorial on the adequacy of case note documentation in a general adult psychiatry setting.

Methods: A comparison of case note documentation of risk factors for violence prior to and subsequent to a risk assessment tutorial.

Results: Prior to the tutorial there were very low rates of documentation of risk of violence. Subsequent to the tutorial, statistically significant improvements in documentation occurred in approximately one third of the items being assessed. Significant improvements occurred in the following; recording a collateral history (from 18%-36%) and previous history of deliberate self harm (from 24%-50%), noting emotions related to violence in the mental state examination (from 2%-24%) and documenting a risk management plan (from 2%-28%). However, levels of documentation remained overall sub-optimal.

Conclusions: Some improvement in case note documentation can result from providing tutorials in risk assessment. However, the ideal format for teaching risk assessment needs to ascertained.
Paroxetine induced mania in pre-adolescence
Authors: Sharkey Louise , O'Donovan Ann
Published: March 2016

Selective serotonin reuptake inhibitor induced mania has been described in adults, and more recently in adolescents. To the authors' knowledge a case in pre-adolescents has not yet been published in the literature. The authors would like to report two cases of SSRI-induced mania. Both cases were pre-adolescent girls, A and B, who had a DSM-IV diagnosis of panic disorder, and were treated with paroxetine.
Attitudes to visits by children to parents hospitalised with acute psychiatric illness
Authors: O'Shea Rory , Sheerin Declan , Canavan Denise , Russell Vincent
Published: March 2016

Background: There is no published research on attitudes of psychiatrists towards children visiting parents who are acutely-unwell and inpatients in psychiatric hospitals. Nor is there information on facilities available for such visits.

Objectives: (I) To assess the attitudes of Irish psychiatrists towards children visiting. (II) To determine the availability of child-friendly facilities within admission units.

Method: A questionnaire was posted to every consultant psychiatrist accepting acute adult admissions in the Republic of Ireland and Northern Ireland.

Results: The response rate was 69%. Ninty-seven per cent were in favour of children visiting. Almost half felt that decisions on visits should depend on the particular situation, considering the child, parent, ward, etc. However, only 11% of units had a room/area designated for children visiting. 90% had no facilities they considered child-friendly on their unit. A majority felt that arrangements for children visiting were inadequate.

Conclusions: This topic is of interest to psychiatrists, and can be contentious, particularly when considering supervision of, and legal responsibility for, children visiting. Guidance on these issues would aid psychiatrists and hospital management. Poor facilities and infrequent visits may be a factor in the early development of stigma towards mental illness. Further research, improvements in facilities and staff training in liaison with children are needed.
Mental Health Policy in Ireland 1984–2004: theory, overview and future directions
Authors: Kelly Brendan D
Published: March 2016

Recent years have seen renewed emphasis on the importance of mental health policy as a key component of health and social policy at both national and international levels. In 2001 the European Commission produced a public health framework for mental health in the EU. In the same year, the World Health Organisation devoted its annual health report to mental health and called on countries to formulate, update and implement mental health policies. The EU and WHO initiatives both recognised that the challenges facing mental health policy makers are increasingly transnational in scope, related to issues such as rapid demographic change, increased transnational migration, the protection of human rights and the implementation of a growing number of international laws, directives and protocols in relation to mental health care.

Significant progress has been made in the development of Irish mental health services over the past 40 years. Nevertheless, many challenges remain. The aims of this paper are to outline:

• Prevailing theoretical perspectives on mental health policy

• Mental health policy in Ireland since the last major policy revision in 1984

• Relevant economic and demographic changes in Ireland since 1984

• Relevant clinical, legislative and policy developments in relation to mental health

• Future directions for mental health policy.

Electronic literature searches were performed using Psyclit (American Psychological Association, 1887–2003), Medline (United States National Library of Medicine, 1985 – 2003), with broad search terms related to mental health policy. Additional books and papers were identified by tracking back through references and consulting with colleagues. Policy documents and selected literature on Irish psychiatric services were reviewed and related to recent literature on mental health policy.
A psychoanalytic psychotherapist working within psychiatry: covert and overt functions
Authors: Stern Julian
Published: March 2016

Within psychiatric practice, psychotherapy occupies a unique role. Not only is it a mode of treatment for some patients, it is also an explanatory model; not only is the psychotherapist called upon to fulfil numerous overt functions within the institution, there are also all sorts of other functions which a psychotherapist may be called upon or expected to fulfil, some more welcome and appropriate than others.

Within medicine the choice of becoming a psychiatrist is often seen as feminine, unscientific, perhaps unsafe and slightly illicit. The same applies within psychiatry, to the choice of psychotherapy, and the decision to leave behind dopamine and clozapine for immeasurable, bizarre, unconscious objects. This paper will describe some of the overt and covert roles in the life of a consultant psychotherapist within the National Health Service (NHS) and then in more detail elucidate these roles with two examples from clinical practice.
Evidence for use of depot neuroleptic medication
Authors: McCauley MacDara , Connolly Gerard
Published: March 2016

Objective:To review the evidence guiding conventional and atypical depot neuroleptic usage.

Method:A search of biomedical electronic databases including Medline, Embase, PsychInfo and Cochrane was performed. Hand searching of journals was also carried out.

Results:Depot neuroleptics are safe and effective in the maintenance treatment of patients with schizophrenia. There is some evidence to support the use of depot neuroleptics in illnesses other than schizophrenia. The evidence base guiding depot usage is sparse.

Conclusions:Although guidelines are emerging there is a pressing need for rigorous well designed trials of depot antipsychotic usage. The advent of atypical depot antipsychotic preparations should stimulate research in this important area of clinical practice.
Interpersonal disturbance in OCD and its place in the professional consultation
Authors: O'Connor John , Fuller Ray , Fell Mary
Published: March 2016

People with obsessive-compulsive disorder (OCD) typically experience their relationships with others with a high level of trepidation and bring their anxieties into their work with professionals. We have written this paper to describe experiences of working with people with diagnoses of OCD and the impression that we have formed about the kinds of relationship that builds up in the early stages of this work. We believe that it is important to consider the quality of these professional relationships because of their impact on the patient's ability to benefit from whatever intervention we propose. Here, we place particular attention on the roles of magical thinking, disturbed relationships and the fear of rejection. The perspective presented here is designed to complement those of other approaches to OCD – including the neurological, behavioural and cognitive-behavioural. The following themes relating to the social and interpersonal experiences of people with OCD are examined here: (a) their general tentativeness and uncertainty in social interactions, (b) their fear of being damaged by others in social interactions, (c) their magical thinking relating to damaging others.
Self-rated prospective memory and central executive deficits in excessive alcohol users
Authors: Heffernan Thomas , Ling Jonathon , Bartholomew Janice
Published: March 2016

Objectives:This study assessed self-reported prospective memory and related central executive processes in a group of excessive alcohol users and non-users. The aim was to assess whether excessive alcohol use is associated with impairments in these two sets of memory processes.

Methods:Eighty participants from the North-East of England were tested. Of these, 40 were excessive alcohol users (using above the recommended weekly ‘safe’ dose of alcohol) and 40 were low-dose/non-users. Each participant was assessed using self-reports of prospective memory (PM) – measured using the Prospective Memory Questionnaire (PMQ) and central executive (CE) processes – measured using the Dysexecutive Questionnaire (DEX). Other drug use, age and strategy use were incorporated into the study as controls.

Results:After controlling for other drug use, age, and strategy use, excessive alcohol users reported global impairments in everyday prospective memory and in their central executive processes, when compared to a low-dose/no-alcohol control group.

Conclusions:These findings suggest that excessive alcohol use has a detrimental impact upon everyday memory – a relatively unexplored area of research. PM and CE deficits should be added to the growing list of neuropsychological sequelae associated with chronic excessive alcohol use.
Patient-controlled benzodiazepine dose reduction in a community mental health service
Authors: Raju Bangaru , Meagher David
Published: March 2016

Abstact

Objectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.

Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.

Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.

Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.
Old age medical patients screening positive for depression
Authors: Winrow Adrian Mark , Holmes John David
Published: March 2016

Objective: The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge.

Method: Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated.

Results: Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study.

Conclusion: Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.
Psychiatric morbidity in a cross-sectional sample of male remanded prisoners?
Authors: Linehan Sally A , Duffy Dearbhla M , Wright Brenda , Curtin Katherine , Monks Stephen , Kennedy Harry G
Published: March 2016

Objectives: To estimate the psychiatric service requirements for the remand population.

Method: We interviewed 232 (42.6%) men, a representative sample of men on remand, using the SADS-L, SODQ and a structured demographic interview.

Results: We found high rates of psychiatric morbidity in our sample. The six month prevalence of psychosis was 7.6%, almost twice the rate in a recent international meta-analysis. Major depressive disorder was present in 10.1% (six month prevalence). Substance misuse problems were also common but there was no significant difference between rates of substance misuse in psychotic and nonpsychotic prisoners. A total of 31.2% had a lifetime history of any mental illness (excluding substance misuse, adjustment disorder and personality disorder).

Conclusions: The high levels of psychiatric morbidity detected in our sample indicate a substantial unmet need for mental health services and addiction treatment services for the mentally ill in Irish prisons.
Delirium in the hospitalised elderly: An audit of NCHD prescribing practice
Authors: Hally Odile , Cooney Colm
Published: March 2016

Objectives: This study was carried out to determine the prescribing of psychotropic medication of non-consultant hospital doctors in the management of delirium and to compare this with best practice guidelines.

Method: A structured questionnaire was forwarded to all non-consultant hospital doctors (n = 95) working at St Vincent's University Hospital and data was collected over a six month period. The questionnaire addressed type, dose and route of psychotropic medication use in delirium as well as adjunctive measures used to manage delirium.

Results: There was a 55% response rate (n = 52). Haloperidol and lorazepam were the two most frequently prescribed psychotropic agents used and over one third of respondents (n = 20) reported the use of risperidone. There was wide variation in doses used and a substantial proportion of NCHDs used higher than recommended starting doses for elderly patients with delirium. In addition, the intramuscular route was reported as the commonest route of administration with a majority of respondents reporting infrequent intravenous route of administration.

Conclusions: The drug choice reported by respondents followed best practice guidelines. However, the wide variation in drug doses used and frequency of parenteral route of administration (particularly intramuscular) indicate the need for increasing awareness of best practice international guidelines. Guidance and clarification regarding the use of atypical antipsychotic medication is required following concerns about their use in dementia.
Music therapy in the treatment and management of mental disorders
Authors: Edwards Jane
Published: March 2016

Objectives: An increasing number of research studies support the benefits of providing music therapy in addition to standard treatment for people who have mental disorders. The objective of this paper was to review and summarise recent research findings in relation to this work.

Method: A review of music therapy studies published since 1994 was undertaken. Criteria for including papers were that they a) were published in English in an indexed, peer-reviewed journal, and b) were conducted as a randomised controlled trial (RCT) or a controlled trial (CT), or c) provided a meta-analysis of existing studies. The large number of papers pertaining to music therapy for older adults who have mental disorders, including Alzheimer's disease and other types of dementia was not included.

Results: The findings support a role for music therapy as a structured interaction that patients are able to use to participate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music therapy is demonstrated to be a beneficial intervention for people who have enduring mental illness. Music therapy invites and encourages participation from people of lower functioning levels and employs a non-verbal medium with which people have prior positive associations and in most cases have lifelong experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.

Conclusions: Music therapy is beneficial for patients receiving care for mental disorders and establishing this therapy within mental health service provision should be considered.
An Irish case of pulmonary emboli secondary to clozapine therapy
Authors: O'Luanaigh Conor , Scully Paul
Published: March 2016

Background:Clozapine is the prototype atypical antipsychotic used for treatment-resistant schizophrenia, but its use has been limited by the well-established association with agranulocytosis. An increased risk of other serious adverse events such as myocarditis and thromboembolism has also been suggested to be associated with clozapine therapy.

Aims:We describe an Irish case of multiple pulmonary emboli detected by CT pulmonary angiogram thought to be secondary to clozapine therapy.

Conclusion:Although clozapine is a very efficacious antipsychotic its many side-effects limit its use. Pulmonary embolism must be remembered as a potential rare side-effect in clozapine therapy. Underlying mechanisms are still unclear although several have been proposed.