bluuebunny/crossref_metadata_2025 huggingface dataset:
An association between functional psychosis and urinary incontinence
Authors: Williams Christopher , Yeomans David , Curran Stephen , Blackwood Gilbert
Published: March 2016

Urinary incontinence commonly occurs in the setting of organic brain damage. However a literature search found no previous reports of an association between urinary incontinence and functional psychosis. Three cases are described in which patients with organic predisposing factors for the development of urinary incontinence showed an association between the degree of incontinence and the severity of their mental illness. It is suggested that the underlying psychosis may have contributed to the worsening of urinary incontinence, perhaps through non-specific factors such as poor attention, memory and psychotic symptoms. An association between functional psychosis and urinary incontinence has not been previously reported, and thus merits further investigation.
The relationship between behaviour disturbance and psychiatric diagnosis in male mentally handicapped adults resident in a long-stay unit
Authors: Walshe David , O'Kelly Mary , Ramsay Louis , Gibson Tessa , Mulvanney Fiona , Kara Ahmed , Corcoran Edan
Published: March 2016

Objective: To investigate the relationship between behavioural disturbance and psychiatric diagnosis in male mentally handicapped adults resident in a long stay unit. Method: The case notes of all 144 residents of St. Raphaels were reviewed. Diagnoses were classified according to the International Classification of Diseases Ninth Revision (ICD-9) and grouped into one of four categories Infantile Autism, Functional Psychoses, Personality/Behavioural Disorder and Emotional Disorders. Carers (Senior Nursing Staff) were interviewed using the Adaptive Behaviour Scale Part 2 (ABS Part 2) as a measure of behavioural disturbance in the preceding year for the 144 residents. Results: 56% of residents had significant psychiatric disorder. Those with a psychiatric diagnosis showed increased behavioural disturbance across a wide range of measures (p<0.001) with Hyperactivity, Self Abuse and Violence showing greatest discriminative power. However there was not a relationship between diagnostic category and pattern of scoring on the ABS Part 2. There was a significant relationship between Degree of Mental Handicap and Psychiatric Diagnostic Category (p<0.001). Neither psychiatric morbidity nor behavioural disturbance was associated with epilepsy, age or duration of stay. Conclusions: Mentally handicapped adults in residential care show high rates of psychiatric disturbance. Those with psychiatric diagnoses exhibit a wide range of disturbed behaviours but similar patterns of maladaptive behaviour occur across the spectrum of psychiatric disorders. These findings refer to a male residential population and cannot be generalised to all mentally handicapped.
Psychiatric hospitalisation in Munchausen's syndrome: is it an answer?
Authors: Arya Dinesh K
Published: March 2016

A patient is presented who resorted to frequent hospitalisation to avoid economic hardships. Psychiatric assessment and admission relieved the medical unit but was achieved at the cost of a valuable psychiatric bed. The question is raised: Is psychiatric hospitalisation an answer?
Side effects of moclobemide in depressed patients refractory to other treatments
Authors: Fahy T J
Published: March 2016

Fifteen consecutive cases of moderate and severe depression were treated with moclobemide in recommended dosage and followed for six months. Eleven developed excitatory side effects including agitation, insomnia, restlessness and aggressivity; five patients reported unreality experiences. Subject to confirmation, these findings, together with indications of similar side effects in published studies and in non fatal overdose, raise the possibility that the potential of moclobemide to cause excitation in depressed patients refractory to other treatments may have been hitherto underestimated.
Clozapine: the Holywell experience with the first 24 patients
Authors: King David J , Mills Philip J
Published: March 2016

Clozapine was substituted for standard antipsychotic drugs in the treatment of 24 chronic schizophrenic inpatients and the response assessed after a mean of ten months. The majority (71%) improved (33.3% markedly), on their previous level of functioning. The response was better in those under 40 years of age, but neither duration of illness nor previous neuroleptic dose appeared to predict response to clozapine. The drug was ultimately discontinued in five (21%) patients – in three because of non-response and intolerance of sedation and in two because of neutropenia.
Who gives the most reliable account of a psychiatric patient's personality?
Authors: Brothwell Judith , Casey Patricia R , Tyrer Peter
Published: March 2016

Objective: To compare the perceived accuracy of diagnostic information derived from psychiatric patients and a range of other informants using a schedule for assessing personality disorders (Personality Assessment Schedule). Method: The Personality Assessment Schedule includes a rating of reliability of the information obtained from whatever source. A record was made of these reliability scores in 405 patients with psychiatric disorder; 146 with both subjects and other informants and 259 with the informant only, and analysed using non-parametric statistics. Results: There was significant variation in the distribution of scores among the four psychiatrists who rated 232 of the interviews with informants, suggesting that inter-individual differences are paramount in deciding who is a reliable informant. Nevertheless, the views of other informants when they were spouses or cohabitees were judged to be more accurate than those of other relatives or acquaintances. No differences were found in the perceived reliability of data from subjects and informants when both were interviewed separately. Conclusions: Subjects and informants are judged to be equally reliable in giving assessments of personality status but the informants who have the closest relationship to subjects, spouses and cohabitees, are judged superior to informants of more distant immediate relationship in the accuracy of their information about personality status.
Emergency psychiatry: a neglected area of a Cinderella service?
Authors: Kehoe Robert F , Pullen Ian M
Published: March 2016

Objectives: To describe existing Scottish psychiatric emergency services, particularly the staffing levels and supervision of junior staff, to assess the level of recording of the urgency of referrals to such services and to determine the approximate rates of emergency presentations. Method: A postal questionnaire was sent to all 29 Scottish psychiatric hospitals, addressed to the physician superintendent or the consultant in charge of emergency services. Twenty-six were returned and further details on these and the other three services were clarified by telephone contact with medical records and medical staff. Description of services, number of presentations, staffing levels and degree of supervision were recorded. Rates of referral were estimated for Health Board populations. Results: Services varied from hospital based walk-in clinics through to community orientated domicillary assessment services. Emergency presentations are usually seen by junior staff in a psychiatric hospital outpatient department, a psychiatric ward or at an accident and emergency department. Out of hours supervision is typically by telephone advice from a consultant. Rates of emergency presentations based on collected and estimated figures were highest in urban areas. Conclusions: Scottish psychiatric emergency services are disparate in nature but all provide a 24 hour service. There is a lack of reliably collected data on the urgency of referrals but estimates suggest that there is a greater need for emergency psychiatric care in the large urban areas. Working definitions are proposed to assist in the classification of the urgency of referrals.
Outpatient detoxification of alcoholics using alprazolam – a two-year pilot project
Authors: McCollam Catherine , O'Shea Brian , Browne Larry , Lynch Mary
Published: March 2016

Objective -To examine the safety and efficacy of alprazolam as an outpatient detoxification agent. Mehtod - Two-year, prospective, uncontrolled study of detoxification from alcohol employing alprazolam in a North Wicklow day centre. The HAD scale was used to measure emotional change. Results -Detoxification was completed in 26 cases. Adverse effects were mild or absent. Significant changes were recorded in both HAD scale scores. Client and staff satisfaction ratings were both high. Conclusions - Alprazolam is a safe and effective detoxification agent in outpatients. The HAD scale provided an objective measure of changes in anxiety and depression in this group of alcoholics. The treated population were older and more often employed than were alcoholics treated in the parent psychiatric hospital.
Psychiatric units in general hospitals — the Irish experience
Authors: McGennis Aidan
Published: March 2016

Objective: Psychiatric units in general hospitals are becoming a key feature of Irish psychiatric practice. This is in accordance with national policy as laid down in “Planning for the Future” in 1984. To date these units have not been the subject of much research. This paper presents baseline data, gives some clinical impressions of how these units are operating, and discusses the implications of these findings. Method: Questionnaires were sent to the medical directors of all 12 psychiatric units in general hospitals in Ireland. In addition, statistical data was collected from the Health Research Board and from the Mental Health Services Section of the Department of Health. Results: All the questionnaires were returned and the results showed that these units were operating in a largely self sufficient way with little usage of local psychiatric hospitals. Outside Dublin 35% of all Health Board admissions are now going to such units, a figure comparable to England and Wales. There was little evidence of patient selectivity as units seemed to be treating the full range of psychiatric disorders. Conclusion: The picture given of general hospital units in Ireland is, in the main, very encouraging. The main problems encountered were the management of disturbed patients and the heavy demands of liaison psychiatry and these two areas would need to be further researched.
Manic-depressive illness — I: clinical characteristics of bipolar disorder subtypes
Authors: McKeon Patrick , Manley Patrick , Swanwick Gregory
Published: March 2016

The clinical and demographic features of 100 bipolar disorder patients, who were categorised into bipolar I, bipolar II, unipolar mania and rapid cycling groups, and who were further classified on the basis of the sequence of occurrence of the manic and depressive episodes within each cycle, are compared. Bipolar I (including unipolar manic) patients, 77% of whom had a sequence of moods where mania preceded depression (Mania-Depression – normothymic Interval: M.D.I.) constituted 69% of the total sample. Six per cent were classified as bipolar II and 25% has a rapid cycling disorder. Patients who had an M.D.I. sequence of moods, whether rapid or non-rapid cycling, had a younger age of onset, a higher male:female ratio and a stronger family history of bipolar disorder than patients whose depression preceded mania (D.M.I.). Unipolar manic patients, 12% of the sample, had a comparable age of onset, a greater family history of bipolarity and more frequent hospitalisations than the bipolar I-M.D.I. group. Rapid cycling patients had a lower mean serum thyroxine concentration than the non-rapid cycling bipolar disorder patients. This study supports the rationale for distinguishing bipolar patients with an M.D.I, sequence from those with a D.M.I, pattern and rapid cyclers from non-rapid cyclers.
“War neurosis” and associated physical conditions: an exploratory statistical analysis
Authors: Watson Ian P Burges , Wilson George V , Hornsby Helen
Published: March 2016

Records of the war service disability claims for Australian Vietnam veterans in Tasmania (n = 751) were analysed to establish patterns of interrelationships between categories of disability. The predicted relationship between psychiatric disability and stress related skin disabilities was strongly supported and relationships between psychiatric and other medical disabilities were found. An exploratory principal components analysis produced three independent components which accounted for 21.2 percent of total variance. Component 1 was interpreted as a general military service component and components 2 and 3 were labelled as stress components. The most likely interpretation of the two stress components was that they reflect differences in profiles of records for disability claims depending on the time when the disability presented. The relevance of the findings is discussed.
Psychotropic management of seizure duration during electroconvulsive therapy: trazodone, a case report
Authors: Kaufman Kenneth R , Kaufman Ettie R
Published: March 2016

The authors summarize a case wherein trazodone was utilized to maintain therapeutic seizure duration during electroconvulsive therapy (ECT) and review the literature in detail (36 references).
Lithium toxicity, hypomania and leucocytosis with fluoxetine
Authors: Wright Padraig , Seth Ram
Published: March 2016

The first case in which lithium toxicity and leucocytosis with hypomania appear to have been induced by the selective serotonin reuptake blocking antidepressant, fluoxetine, is described. The possible pathophysiology of this interaction is discussed.
A survey of manual preference, skill and strength in undergraduates
Authors: Moynihan John B , Breathnach Caomhghin S
Published: March 2016

Objective: To examine hand preference, hand skill and hand strength in university undergraduates in order to determine the most reliable index of handedness.

Method: The Edinburgh Inventory, a group test of handedness by marking dots in circles, and a standard dynamometer were used with 248 (148 female, 100 male) subjects.

Results: No statistically significant correlations were found between hand skill and strength, or between hand preference and strength. A significant correlation between skill and preference was found in the male right-handed group of 93 students.

Conclusion: It is not possible to demonstrate whether preference or skill is the better index of handedness; a standardised method for assessment of hemispheric dominance for handedness is required; in the meantime the criterion used in a specific study should be explicitly stated in any citation of that study.
Cognitive therapy of agoraphobia in reaction to physical illness: an uncontrolled study
Authors: Bishay Nagy R , Tarrier Nicholas , Roberts Anthony P
Published: March 2016

This study describes the uncontrolled treatment of six patients who developed an agoraphobia-like syndrome following physical illness. They all revealed danger-related cognitions associated with possible sequelae of their physical illness. Cognitive therapy based on realistic assessment of risks and a strategy to minimise them was associated with improvements that were maintained at six-month follow up. The study identifies the specificity of the danger-related cognitions and points to the need for further studies to assess the size of the problem, and the need for controlled trials to assess the outcome of the treatment.
The anonymous patient: clinical characteristics of patients unidentified at presentation
Authors: Meagher David J , Collins Aidan G
Published: March 2016

Objective: The aim of this study was to investigate the characteristics of patients whose identities are unknown at presentation to psychiatric services.

Method: We retrospectively reviewed 12 years of presentations to an emergency psychiatric unit and identified 37 anonymous presentations in that period. Cases were assessed with regard to demographic data, legal status, reasons for presentation, putative diagnosis at presentation, eventual documented (ICD-9) diagnosis, previous history, duration of anonymity, method of identification and re-occurrence.

Results: 0.6% of all patients who presented during the study period were unidentified for at least 24 hours. Patients were young (mean age 33.6 years). Over half were of foreign nationality (53%). The majority were suffering from major psychotic illnesses (86%). When compared with all admissions during the study period, schizophrenia and drug-induced psychoses were significantly more common in the group unidentified at presentation. Malingering, organic psychiatric disorders and dissociative states were not commonly encountered underlying diagnoses. All of our patients were subsequently identified. Successful identification methods included self admission, careful examination of personal belongings, careful history taking, liaison with police and recognition by staff. Patients frequently had a previous psychiatric history (91%). Recurrence was uncommon.

Conclusion: The anonymous presentation represents a unique challenge to the investigative skills of the psychiatrist. The application of basic strategies enables the successful identification of the majority of cases.
A fatal complication of clozapine - induced agranulocytosis
Authors: Mangan Brian , Toal Martin J
Published: March 2016

Clozapine (Clozaril-Sandoz) is an atypical anti-psychotic drug used for the treatment of resistant schizophrenia. We describe the first fatal outcome as a consequence of neutropenia in the British Isles attributed to the use of clozapine. This death occurred despite proper monitoring by the Clozaril Patient Monitoring Service (CPMS) and full clinical vigilance.
Conolly
Authors: Breathnach Caoimhghin S
Published: March 2016

John Conolly [1774 - 1866] was born at Market Rasen into a collateral branch of the prominent Castletown, Co. Kildare, family. After graduating at Edinburgh in 1821, his efforts in clinical practice, bolstered by indifferent forays into medical journalism, were repeatedly unsuccessful. Thus, at the age of 45, over the course of four years as Resident Superintendent of Hanwell Asylum in Middlesex, he became one of the leading psychiatrists in England. Though his consulting practice blossomed thereafter, it is as the consummate, kindly administrator responsible for the introduction of non-restraint in public asylums in England and Wales that he is remembered today.
Public attitudes to depression: a national survey
Authors: McKeon Patrick , Carrick Siobhan
Published: March 2016

In a national representative survey, 1,403 people were interviewed on their attitudes to depression and its sufferers and their understanding of the causes, treatability and treatment of depression. Some two-thirds of the interviewees regarded depressives as being neither mentally ill, weak willed, nor as feeling sorry for themselves. Stress, bereavement and hereditary were considered to be the most frequent causes of depression. Seventy-three per cent said that depression could be successfully treated. While 81 per cent recommended getting professional help, only 17 per cent mentioned their GP as a source of treatment for depression. People who had depression, or who had a friend or relative who had depression and those who had visited a patient in a psychiatric hospital expressed more positive attitudes to depression and its management.
Lack of effect of electroconvulsive therapy on CSF peptide concentrations in schizophrenic patients
Authors: Cooper Stephen J , Johnston C F , King David J
Published: March 2016

The effects of a series of 6 ECT treatments were observed on the CSF concentrations of neurotensin and substance-P in eight patients suffering from schizophrenia. Four patients were previously drug free. No significant effects of ECT were observed.
Unilateral auditory hallucinations – a case report
Authors: Khan Asaf M , Krishnan Vallepur H R
Published: March 2016

A case of unilateral auditory hallucinations with endogenous depression is described. Treatment of depression improved the hallucinations. The relationship of lateralisation phenomena with cerebral hemispheric dys-function and peripheral ear disease is discussed.
To reminisce or not to reminisce
Authors: Jackson Anne
Published: March 2016

Interest in the process of reminiscence has increased in recent years. This article reviews changing attitudes to reminiscence and the various theories as to its function. Some clinical applications are discussed, in particular its potential therapeutic value in dementia.
Comments on lithium treatment
Authors: Schou Mogens
Published: March 2016

Lithium treatment, employed in western countries by 1 – 1.5 persons out of every 1,000 in the population, might with advantage be used more for mania and as a supplement to antidepressants in treatment refractory depressions. Prophylactic efficacy is as good in unipolar depressive as in bipolar illness. Start and discontinuation of prophylactic treatment is decided jointly by patient, spouse and psychiatrist. Treatment intensity (dosage, serum level) should be fine-tuned to lowest effective level. Treatment safety is ensured by observation of guidelines and precautions, and again cooperation between the psychiatrist and the carefully instructed patient and family is essential.
Antidepressants: uses and attitudes among consultant psychiatrists – A questionnaire study
Authors: O'Shea Brian
Published: March 2016

An audit of Consultant Psychiatrists' views on and uses of antidepressant drugs is reported. At present senior prescribers largely opt for the older tricyclic antidepressants despite a knowledge of their shortcomings. MAOIs are less popular and newer drugs are viewed cautiously and apprehensively. Lofepramine is largely viewed as an alternative to dothiepin and amitriptyline. Non-drug strategies in the management of depression consist largely of support, environmental manipulation and electroconvulsive therapy. The relatively novel treatment, cognitive therapy, has a strong minority following.
Automatism — a medico-legal conundrum
Authors: d'Orbán Paul T.
Published: March 2016

During the past 35 years, a series of Court decisions have developed and refined the concept of automatism, defined in law as unconscious involuntary action. Two varieties of automatism have come to be recognised. In insane automatism, the absence of mens rea is caused by disease of the mind, and the defence leads to an insanity verdict with compulsory detention in hospital. In non-insane automatism, the mind is affected by some external factor and the findings result in complete acquittal. However, from the medical point of view, the distinction between exogenous and endogenous factors is naive and may lead to decisions that are contrary to natural justice and common sense. The main practical problems arise because of the mandatory commital to hospital when there is an insanity verdict and legal reform is required.
Noradrenaline and animal cognitive processes: implications for dementia
Authors: Moran Paula , Leonard Brian E.
Published: March 2016

Recent research on the neurochemical deficits that accompany Alzheimer's disease (AD), senile dementia (SD) and Korsakoff's dementia (KD) have prompted renewed interest in the involvement of central cholinergic systems in learning and memory processes. Evidence for the role of cholinergic systems in the dementias is now overwhelming and has been reviewed in detail elsewhere, e.g. Briefly, such evidence includes findings of decreased cortical activity of the cholinergic marker enzyme choline-acetyltransferase (CAT), reduced activity of the acetylcholine degrading enzyme acetylcholinesterase (AChE), and degeneration of the cholinergic cells of the nucleus basalis of Meynert (nBM) and medial septal nucleus (MS). Pharmacotherapy based on a knowledge of these cholinergic deficits has included (i) ACh precursor therapy, e.g. choline, lecithin; (ii) anti-cholinesterase treatments e.g. physostigmine, tetrahydroaminoacridine (THA), disopropylfluorophosphate (DFP); or (iii) cholinergic synthesis agonists e.g. oxotremorine, arecholine. These have had some success, but it has only been modest. While lack of efficacy has been attributed in specific cases to the pharmacokinetics of some of these drugs e.g. physostigmine, bethanecol, a more general explanation is that SD not only results from a cholinergic deficit but also involves abnormalities in many other neurotransmitter systems.

Thus, more recent findings on the neuropathology of AD and the dementias have implied that while a cholinergic hypothesis of cognitive dysfunction in dementia has strong support, dementia can be considered to be a multi-system disorder. Newer studies indicate pathologies involving serotonergic, dopaminergic, glutaminergic and noradrenergic systems. This review will focus on dysfunction of the noradrenergic system and will conclude that degeneration of this system is an important substrate of cognitive impairments found in dementia.
Coping with multiple sclerosis
Authors: Greene Sheila M. , Hickey Anne
Published: March 2016

A questionnaire containing the Multidimensional Health Locus of Control scale, a focus of coping scale, the Centre for Epidemiological Studies Depression scale, and the Hopelessness scale was posted to 50 male and 50 female Dublin members of the Multiple Sclerosis Society of Ireland. The aim of the study was to examine ways in which people with multiple sclerosis cope with their illness, and to determine whether the coping strategies used were effective or ineffective in terms of the relations between the scales that were used. Sex differences on each of the scales were also examined. Results indicated that there were some sex differences on the locus of control scale. However, no sex differences were found on the focus of coping, or on the depression and hopelessness scales. Rather, both sexes were found to have mean depression and hopelessness scores above what is considered to be the norm for both of these scales.
Aggressive behaviour among mentally handicapped females in a closed villa
Authors: McGarry Philip J.
Published: March 2016

Minor aggression is common in a closed female villa in a hospital for the mentally handicapped. In this study it occurred most frequently between 8a.m. and 10p.m. with a lunch-time peak. More incidents occurred on Saturday than on any other day. Few of the patients were psychotic and incidents were related to meal-times and reduced supervision. The most common targets for aggressive behaviour were property and the patient herself. The most common locus for aggression was outside the Sister's office. Attention to improving communication skills and providing more supervision should help to reduce the level of aggression.
Kleine-Levin Syndrome: a female case report and review
Authors: Cooney John A.
Published: March 2016

The Kleine-Levin Syndrome (KLS) a rare disorder comprising of periodic bouts of hypersomnia and megaphagia is reviewed. The syndrome chiefly affects males. The four accepted female cases in the literature are reviewed and a new female case described. This patient had an IQ in the normal range, unlike the other three female cases where the IQ was measured. She showed an abnormal Cortisol rhythm during both a well and an unwell phase replicating the findings of other workers in some KLS patients. This patient showed normal dexamethasone suppression, a test not previously reported on in KLS. The patient also smoked excessively during the bouts, an occurrence not previously remarked on in this disorder.
CT and MRI Abnormalities in Schizophrenia: The New Developmental Biology of Psychosis?
Authors: Waddington John L
Published: March 2016

Despite more than a decade of studies, biological psychiatry has yet to satisfactorily resolve the issue of whether new brain imaging technologies reliably indicate the presence of abnormal cerebral morphology in schizophrenia. The present Perspective offers an alternative view on this topic, as a counter-point to one previously offered in the Journal. It addresses several of the methodological problems inherent to such studies, and evaluates some of the more recent aspects of the literature. Those structural abnormalities which have been reported in schizophrenia appear most readily explicable as a consequence of neurodevelopmental anomalies.
Prediction of Rapid Relapse Following Lithium Discontinuation
Authors: Mander A.J.
Published: March 2016

All twenty-nine bipolar 1 patents who satisfied DSM-111 criteria following their first hospitalisation for mania and subsequently discontinued their prophylactic lithium after a mean of 29 ± 21 months were studied. Patients were classified into poor prognosis (relapsed within 3 months of discontinuation, n = 8) and good prognosis groups (relapsed after 3 months or did not relapse, n = 21). Poor prognosis patients were more likely to have been prescribed additional psychotropic medication in the previous year (P = 0.026) and had higher serum lithium levels immediately prior to lithium discontinuation (P = 0.0043). Recent additional psychotropic medication may indicate that the patient is at an increased risk of early relapse if lithium prophylaxis is being stopped for any reason. The increased risk for those patients with higher lithium levels suggest that gradual phased reductions would be prudent.
Intentional Self Burning by Psychiatric Patients
Authors: O'Sullivan Geraldine , Kelleher Michael J
Published: March 2016

Suicide and attempted suicide are common phenomena amongst psychiatric inpatients and outpatients. Self-immolation or self-incineration are dramatic attention seeking events which may have religious or political significance. Deliberate self burning which incorporate these may also encapsulate elements of attention seeking, parasuicidal and suicide behaviour. The present study shows that psychiatric inpatients who choose to injure themselves by self burning are a seriously disturbed group whose intention is largely suicidal and who have a previous history of attempted suicide. They tend to be female, single, suffering from either schizophrenia or personality disorder in contrast to the majority of people who take their lives by other methods who tend to suffer from depression, alcoholism or both.
Supervision of the Community Meeting Where Hospital Closure is an Issue
Authors: Duke Peter J
Published: March 2016

This paper is an attempt to address issues encountered in the Supervision of a community meeting in a psychiatric unit which is scheduled for closure. An initial practical problem which took the form of difficulty in meeting for the supervisory session is examined from a psychodynamic perspective and related to difficulties encountered by the therapists in their work with the patient group and ultimately to the dynamics of the patients themselves.

Material provided by patients and staff is discussed in terms of the concept of relatedness to the non-human environment as described by Searles and it is suggested that this may contribute to the understanding of the process of hospital closure as it affects patients and staff.
Obsessive compulsive disorder and multiple sclerosis: a case report implicating serotonergic dysfunction
Authors: Freyne Aideen , Shelley Rory K
Published: March 2016

A patient who developed obsessive compulsive disorder within a year of developing multiple sclerosis is described. Possible reasons for an association between these two conditions are discussed. The role of serotonergic pathway dysfunction in obsessive compulsive disorder is also suggested by the pharmacological response in this case.
Community psychiatric nurse aftercare for alcoholics
Authors: Patterson Diana G , McCourt Maureen W , Shiels Joyce R A
Published: March 2016

One hundred and twenty-seven white male alcoholics, treated in a rural setting, were assigned to one of two groups. Seventy-three subjects received intensive aftercare by Community Psychiatric nurse and fifty-four control subjects received standard aftercare with outpatient appointments. Subjects were assessed one year after treatment. Fifty-four per cent of those given Community Psychiatric Nurse follow-up were completely abstinent compared with twenty per cent of those in the control group. Those receiving Community Psychiatric Nurse follow-up were less likely to have blackouts, hospital admissions or marital discord in the year following treatment. They were more likely to attend hospital meetings regularly. This form of aftercare is an effective way of maximising the benefits of expensive inpatient treatment.
Anorexia nervosa in males
Authors: Buckley Peter , Freyne Aideen , Walsh Noel
Published: March 2016

Anorexia nervosa in males is relatively uncommon and therefore is difficult to research. Nevertheless, the study of such cases is important and may yield valuable clues to the aetiological mechanisms and expression of this disorder. This study compared the characteristics of 12 males with primary anorexia nervosa with 36 female anorectics. The pattern of the disorder was remarkably similar in both sexes. Our findings are discussed with relevance to the available literature on this topic.
Compulsive water drinking, water intoxication and alcohol abuse
Authors: Cooney John A.
Published: March 2016

Using urine specific gravity testing to estimate fluid intake Compulsive Water Drinking (CWD) was found to occur, without an age or sex bias, in 19.1% of rehabilitation inpatients in a Canadian psychiatric hospital. Chart review indicated that Water Intoxication had not been a major problem for these patients during their hospitalisation. Nursing opinion appeared to be a relatively weak test for CWD. In a comparison with age and sex matched control patients no significant association with alcohol abuse for the CWD patients or their relatives was found.
Moving home: the effects of residential transfer on the behaviour of adults with a mental handicap
Authors: McEvoy John
Published: March 2016

This study examines the changes in behaviour following residential relocation in 2 groups of adults with mental handicap. Both groups were transferred (one from the community and one from psychiatric hospitals) to small bungalow dwellings in a village type setting at a centre for persons with mental handicap. Relocation had a major impact on a number of behaviours, most prominently, ‘domestic activities’. The impact of the transfer on both groups, the relevance of the findings for future transfer projects and suggestions for future research are discussed.
The prevalence of alcoholism in an Irish general hospital
Authors: Schofield Ann
Published: March 2016

In an Irish general hospital 82 admissions were given the MAST questionnaire and 331 patients were given the CAGE questionnaire for alcoholism. Of those who were given the CAGE 67 scored 1.0 or more, (maximum socre: 4.0), and 36 scored 2.0 or more, denoting a prevalence of probable alcoholism in this population of 11%.

Of those scoring 3.0 or 4.0 on the CAGE, 38% of males and 100% of females claimed to have abstained from alcohol for at least one year and 54% and 100% respectively had a heavily drinking relative.

Twenty-three per cent of patients tested with the CAGE and MAST questionnaires claimed never to have drunk alcohol.

The number of patients diagnosed in the medical charts as having an alcohol problem was fewer than those detected by the CAGE questionnaire. It is suggested that the CAGE questionnaire may be a simple and efficient way of detecting excess alcohol consumption in a general hospital population.
The Charles Bonnet Syndrome associated with vascular pathology – a classical presentation with a very atypical course
Authors: Ballard Clive G , Chithiramohan Ramalingam N , Handy Sumithra
Published: March 2016

We present a case of the Charles Bonnet syndrome the onset of which appears to have been associated with vascular pathology. The syndrome typically involves the appearance of mute, colourful and pleasing visual images with the retention of insight into their hallucinatory nature. However, the case progressed in a very atypical way and a system of paranoid delusions developed around the visual hallucinations. The syndrome is reviewed and the possible reasons for the atypical course discussed.
Feigned psychosis - a case of factitious disorder
Authors: Buckley Peter , Campbell Aisling
Published: March 2016

A number of psychiatric syndromes are characterised by the conscious or unconscious production of factitious symptoms. These include Munchausen Syndrome, the Ganser Syndrome and malingering. Here we describe a patient who rapidly changed her symptomatology according to material from her environment. Her presentation does not meet criteria for any of the above syndromes, but is best described as a factitious disorder (DSM-III-R). This case provides a framework for discussion of the validity of this concept.
Disulfiram neuro-toxicity: a review and report of a case of fluctuating neuro-encephalopathy
Authors: Webb Marcus
Published: March 2016

A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.
Thinking, discourse and the denial of history: psychodynamic aspects of mental handicap
Authors: McCormack Brendan
Published: March 2016

This paper explores the contribution of psychoanalytic theories to mental handicap and proposes that mental handicap can be seen primarily as a problem of communication with others (discourse), with oneself (thinking) and with one's own past (history).

This paper also examines concepts of curiosity and thinking, knowledge of history and mental handicap as discourse. To illustrate certain points, examples from case histories are used (real names not used).
Violence and Schizophrenia — a study of the occurrence and clinical correlates of violence among schizophrenic patients
Authors: Buckley Peter , Walshe David , Colohan Hubert A , O'Callaghan Eadbhard , Mulvany Fiona , Gibson Tessa , Waddington John L , Larkin Conall
Published: March 2016

The relationship between mental illness and violent behaviour, particularly in schizophrenia, is an important issue both for health care professionals and the general public. Estimates of the prevalence of violence among schizophrenic patients vary according to patient selection, patient setting, and the definition of violence employed. This study investigated the occurrence and characteristics of violence and its clinical correlates among 698 schizophrenic patients who had been treated in an Irish general psychiatric hospital. Violent behaviour occurred in 16% of patients. The vast majority of acts were of a minor nature and serious physical assault was noted in only 1% of cases. Our findings are discussed with reference to the available literature.
Substance misuse among psychiatric hospital in-patients
Authors: Johnson Bankole A
Published: March 2016

A review was made of the case notes of all patients admitted to the Psychiatric unit of an East London teaching hospital in 1975, 1980 and 1985. Over the ten year period, the total number of admissions showed little change. In contrast, admissions associated with substance dependence tripled, and those related to substance induced organic mental disorder increased sevenfold. These findings suggest that psychiatrists in acute units should be on the alert to detect cases of psychiatric disorder complicated by substance misuse.
Adinazolam sustained release formulation in the treatment of panic disorder: a pilot study
Authors: Sheehan David V. , Raj Ashok B , Harnett-Sheehan K. , Soto Sonia , Lewis Carl P.
Published: March 2016

This is the first report on the use of the sustained release formulation of adinazolam in the treatment of panic disorder. A six week open lable trial followed by a 1-6 week taper/discontinuation phase was used to assess the safety and efficacy of adinazolam (Deracyn-SR) in the treatment of 10 outpatients with panic disorder and agoraphobia. Adinazolam-SR was well tolerated and produced a rapid improvement in panic and limited symptom attacks, anxiety, phobias, disability, and depressive symptoms. Mean ±S.D. duration of therapeutic action of each dose of this formulation was 12.2±2.3 hours. This is longer than the duration of therapeutic action of other benzodiazepine formulations studied to date for the treatment of panic disorder. Frequency of relapse, rebound and withdrawal symptoms was similar to that found on taper/discontinuation from alprazolam.
Wilson's disease and the neuroleptic malignant syndrome
Authors: Buckley Peter , Carmody Eamonn , Hutchinson Michael
Published: March 2016

Wilson's Disease (Hepatolenticular degeneration) is an uncommon disorder of copper metabolism, characterised by excessive copper deposition in the liver, brain and eyes. Psychiatric symptoms were prominent in eight of the twelve patients originally described by Wilson some 88 years ago. Since then a wide range of psychiatric presentations have been documented including behavioural disturbances, affective psychoses, schizophrenia-like psychoses, intellectual deterioration and dementia. Here we describe a patient who presented with a psychiatric disturbance, was treated with neuroleptic medication and subsequently developed Neuroleptic Malignant Syndrome (NMS).
Alcohol induced Parkinsonism in an ex-pugilist
Authors: Byrne Alan , Delaney William , Boardman R H , Bawa Hussam
Published: March 2016

The case of an ex-pugilist who developed a reversible Parkinsonian syndrome in response to ethanol intoxication, is described. The relationship between ethanol abuse and altered function in the nigro-striatal system is examined, and the relationship to boxing encephalopathy is reviewed. The patient described was the third neurological casualty in a family of boxing brothers, and suggestions are made regarding the potential dangers of this sport. The syndrome of alcohol induced Parkinsonism in an ex-pugilist has not previously been described in the literature.
Neural integration of the hormonal contribution to homeostasis
Authors: Breathnach CS
Published: March 2016

Apart from well known areas of overlap between endocrinology and psychiatry (e.g. studies, in psychiatric disorders, of neurohormones and of the response to manipulations of hypothalamic-pituitary-target gland axis, and analysis of behavioural and psychological disturbances in endocrinological disorders) there is a more intimate intrinsic relationship between the brain and the endocrine system which is less well known or studied. Many of the extracranial endocrine glands have autonomic innervation. Like the pituitary gland which is under direct neural (as well as humoral) diencephalic control, the extracranial endocrine glands are under direct neural control, integrated by the hypothalamus and “head ganglion of the autonomic nervous system”. Yet it is only in the case of the pancreatic islets that this integration has been clearly defined. It is postulated that by this innervation the somatic endocrine glands can respond to homeostatic needs with a rapid initial secretion before the more sustained outpouring of humoral agents typically regulated by blood-borne constituents including pituitary hormones. This is a vast area awaiting further investigation.
Current issues in monoamine oxidase inhibitor treatment
Authors: O'Brien Sinead , McKeon Patrick
Published: March 2016

Interest in the monoamine oxidase (MAO) inhibitors has been revived over the past fifteen years since the publication of studies and reviews which argue their relative safety and efficacy in certain patient subgroups. The authors conclude that there is a continuing role for the MAO inhibitors in treating atypical depressive illness and panic disorders. Careful selection of patients to be commenced on MAO inhibitor treatment is advised. When prescribed alone or in combination with lithium there is evidence to support a usefulness for MAO inhibitors in depression resistant to the tricyclic antidepressants. Their efficacy in the depressed phase of bipolar affective disorder or in combination with the tricyclic antidepressants remains unproven. The risk of anaesthesia while a patient is receiving MAO inhibitor treatment may be less than heretofore believed. There is realistic hope of finding among the short-acting selective MAO inhibitors an effective antidepressant which is also free from tyramine related effects. With the increasing difficulties of evaluating new drugs on account of ethical and governmental constraints, it may however be some time before the preliminary hopeful findings can be substantiated in larger groups of patients.
Serological markers of hepatitis B in long-stay patients in a psychiatric hospital
Authors: Gannon Miriam A. , Murphy Denis J. , Corish John F.
Published: March 2016

Hepatitis B surface antigen and antibody to hepatitis B core antigen were measured in 232 long-term psychiatric patients. The aims of the study were to determine the prevalence of infection and to relate it to factors such as age, sex, duration of hospital stay and diagnosis.

There was both an increased rate and increased evidence of past infection amongst the patients tested relative to the general population. There was no statistical significant difference between the antibody positive group compared to the antibody negative group for age, sex and duration of hospital stay, unlike that found in studies of mentally handicapped patients. There was a positive association between the presence of antibody and patient diagnosis. Patients with mental handicap appear to have a predilection for hepatitis B.

Further work needs to be done to elucidate the epidemiology of hepatitis B in psychiatric patients and evaluate the reservoir of infection present.
Eating disorder, substance abuse and prostitution
Authors: Cooney John A.
Published: March 2016

The case of a 20-year old female prostitute with a five year history of anorexia nervosa, bulimia nervosa and substance abuse is described. The author was unable to find a previous reference to eating disorders occurring in a prostitute.
Reversible sperm changes in an abstinent alcoholic
Authors: Katta Balaraju B , Taneja Neelum , Mohan D
Published: March 2016

Alcohol is a reproductive toxin in animals but little is known about its effects on the production of semen in humans. Nothing is known about the reversibility of any changes. The authors here present a case of alcohol dependence with abnormal semen parameters which improved after two months total abstinence.
Further thoughts on Graz 807 and Vienna 13314
Authors: NORTON MICHAEL LEE
Published: March 2016

Graz, University Library, MS 807 and Vienna, Austrian National Library, latin 13314 have been studied intensively for more than a century, yet unsolved problems remain. Following a brief discussion of the sources and relevant scholarship, the antiphons for the Rogationtide processions in the gradual portions of both manuscripts I examine, along with a supplementary set of Rogationtide antiphons added to the Vienna codex. I then take a closer look at the expanded descriptions for the rites for Holy Thursday, Good Friday and Holy Saturday in the Vienna manuscript's sacramentary. From this evidence, I reaffirm the association of the liturgies in Vienna 13314 and Graz 807 with the canons and canonesses of Klosterneuburg respectively, and argue that the twelfth-century additions to Vienna 13314 suggest that the two manuscripts were kept together already in the twelfth century, most likely at the Augustinian monastery at Seckau. I conclude with further observations on the much-discussed odd placement of the Dedication of the Church in the Sanctorale of Graz 807 and on the occasion that would have brought the two manuscripts to Seckau.