bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of seclusion in a general hospital acute psychiatric unit
Authors: Prinsloo Bernice , Noonan Angela
Published: March 2016

Objective: To examine the frequency of use of seclusion and the factors associated with its use in Lakeview Unit, a 29-bedded acute psychiatric unit in Naas General Hospital.

Methods: A survey was carried out involving a retrospective chart review of all patients secluded over a 12-month period, as well as a review of the seclusion register for this period. Secluded and non-secluded patients were compared for gender, nationality, age, diagnosis, duration of admission and admission status by reviewing discharge summaries of all patients admitted during the 12-month period.

Results: Most (75%) of the secluded patients were secluded only once. Half of seclusion events were initiated in the first week of admission. Length of time spent in seclusion ranged from 50 minutes to 96 hours, with a mean duration of 25 hours 20 minutes. Seclusion was most often associated with risk to others and risk to self. Alternatives to seclusion considered included verbal de-escalation, medication, special nursing, single room accommodation and time out Male and non-Irish patients were more likely to be secluded. There was no significant difference between secluded and non-secluded patients in terms of age. Patients with psychotic disorders tended to be secluded more frequently than others, followed by patients with bipolar affective disorder and substance use disorders. Longer duration of admission and involuntary admission status were strongly associated with seclusion.

Conclusion: Seclusion remains an important part of psychiatric practice on Lakeview Unit, and reflects indirect measures of illness severity. In order to reduce the duration of seclusion episodes, the development of alternative containment strategies needs to be addressed. Seclusion audits should be carried out regularly to ensure that best practice is adhered to.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL): a familial cause of depression and headache
Authors: O'Rourke Killian , Crumlish Niall , Murphy Darra , Stack John , Murray Brian
Published: March 2016

A 31 year-old man with a history of a depressive episode presented with acute severe ‘thunderclap’ headache. Magnetic resonance imaging (MRI) revealed abnormalities typical of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), which was subsequently confirmed by genetic analysis. The psychiatric features of this genetic cause of depression and headache are discussed.
Self-injurious behaviour and the serotonin link: two case illustrations and theoretical overview
Authors: Jawed Syed Hasan , HR Krishnan Vallepur , Cassidy Géraldine
Published: March 2016

Self-injurious behaviour (SIB) is one of the challenging behaviours that is exhibited by people with severe learning disabilities. Various current aetiological theories of SIB have failed to provide a feasible model of care for this complex clinical problem. Recent advances in the understanding of serotonin neurotransmitter function may provide a way forward in the management of SIB. Case histories of two people whose SIB responded to antidepressant medication are described. Possible implication of serotonin neurotransmitter function in the causation of SIB is explored and relevant recent literature is reviewed.
The ‘whiplash’ enigma: undetected psychological factors? A pilot study
Authors: Sheehan John D , Maguire Ann , Ryan John P , Vella Leo
Published: March 2016

Studies in general medicine and general practice have shown that psychological disorder is frequently undetected and that it may exacerbate the morbidity of physical conditions. The aim of this study was to detect possible psychological disorder in patients with soft tissue neck injury (STNI) attending a 660 bed teaching hospital in Dublin. Using the General Health Questionnaire-30, 100 STNI patients were compared with 100 consecutive other attenders at the Accident and Emergency Department. There was a significantly greater prevalence in the frequency and severity of psychological disorder in the STNI group, who also were more likely to have a history of depression.
Groupwork with HIV positive drug misusers in prison
Authors: Pugh Julian
Published: March 2016

Objective: The groupwork programme in this study sought to engage HIV positive drug misusers within a prison setting in order to introduce ideas and information, and by so doing promote desired behavioural changes in terms of risk behaviour and drug addiction. Such an effort was also seen as a strategy to help prisoners cope with imprisonment and to prepare them for the demands that they might face following release.

Method: Various methods of giving information and discussion were employed in order to influence members' views and behaviour. The interactions between group members were recorded using a modified version of Bale's Interaction Process Analysis Instrument during each session. In this way it was possible to analyse individual member's functioning as well as that of the whole group over the duration of the programme.

Results: While significant changes in members' views and behaviour could not be proven, an analysis of the group's communication, control, evaluation and decision making profiles reflected effort and engagement in tackling the subject inputs. Analysis of individual member's contributions was, however, open to more speculative interpretation.

Conclusion: The positive response from group members, combined with an analysis of the results suggests that the approach adopted in the programme was an encouraging step in devising an acceptable and relevant educational and treatment strategy in dealing with this usually reluctant client group, many of whom are unresponsive to traditional treatment methods.
Barriers to the diagnosis and treatment of depression in the community dwelling elderly
Authors: Lawlor Brian A
Published: March 2016

There is broad agreement in the literature that depression in the community dwelling elderly is under-diagnosed and under-treated by general practitioners. Somatisation, overlap with medical illness, bereavement and atypical presentations of depression in this age-group may contribute to the difficulties in diagnosis in primary car settings. Furthermore, the apparent reluctance of primary care physicians to treat depression in the elderly may reflect the mistaken notion that depression in this population is a benign condition, an understandable reaction to physical illness and as such untreatable. Fundamental changes in the patterns of collaboration between psychiatry and general practice will be necessary to overcome these barriers to the detection and treatment of depression in the community dwelling elderly.
Prader-Willi syndrome and psychotic symptoms: report of a further case
Authors: Clarke David J , Webb Tessa , Bachmann-Clarke Joyce P
Published: March 2016

A 21 year-old woman with Prader-Willi syndrome (PWS) and a delusional disorder (paranoid psychosis) is described. Other reports of psychoses associated with PWS are reviewed. Reasons for the co-existence of the two disorders are considered, with discussion of the possible role of auditory information processing deficits in the genesis of psychotic symptoms. Such symptoms must be differentiated from maladaptive behaviours not arising from psychosis, the latter being relatively common in PWS. Treatment with a small dose of flupenthixol greatly reduced the impact of the patient's psychotic symptoms, with a corresponding improvement in her quality of life.
Schizophrenia and Down's syndrome
Authors: Duggirala Chandrudu , Cooper Sally-Ann , Collacott Richard Anthony
Published: March 2016

There are few reports in the literature of schizophrenia in individuals with Down's syndrome, but a suggestion that such individuals may be protected from schizophrenia. We report six cases of schizophrenia fulfilling ICD-10 guidelines, occurring in people with Down's syndrome. In one case, hypothyroidism was associated. Response to neuroleptic treatment was good. Reasons for the paucity of previous reports on this association are discussed.
Clozapine in treatment-resistant schizophrenic patients: preliminary results from an open prospective study
Authors: Jalenques Isabelle , Albuisson Eliane , Tauveron Igor
Published: March 2016

Objective:This report describes an open prospective study of the effects of clozapine on positive and negative symptomatology in treatment resistant schizophrenic patients.

Method:In this prospective study, 15 DSM-III-R schizophrenic patients, who had failed to respond to various neuroleptics were followed up for a period of 21 months (median: 9; 25th and 75th percentiles: 4-10). When clozapine treatment was initiated, the mean duration of the illness was 16 +/-9 years. Brief Psychiatric Rating Scale (BPRS) scores, BPRS ‘positive symptoms’ and BPRS ‘anergia factor’ scores were all rated at days 0 and 15, months one, two and three and every three months thereafter.

Results:Significant improvements in total BPRS scores, BPRS positive symptoms and anergia factor were recorded and resulted in two distinct patterns of outcome. The improvements in BPRS scores translated into marked changes in health care utilisation and in sheltered employment. Of the side effects noted, dry mouth was more common in the first month after wash-out (three patients), while hypersalivation was more frequent after this period (eight patients). There was no agranulocytosis in this cohort. Two cases of eosinophilla occurred during the first month. Weight gain affected six patients.

Conclusions:We found that clozapine offers particular benefits for some treatment-resistant schizophrenic patients despite the increased hematologic risk. Our study also indicates that the beneficial effects of clozapine are delayed in relation to negative symptoms as compared with positive symptoms.
Neurosyphilis and secondary mania in elderly patients
Authors: Dawson Gerald , Baldwin Bob
Published: March 2016

A case is described of an elderly man with secondary mania caused by neurosyphilis. This is thought to be the first such case in an elderly person. The implications for routine sero-testing are discussed.
Absent without leave – can we predict those who go AWOL?
Authors: Farragher Barbara , Gannon Miriam , Ahmad Ishtag
Published: March 2016

Objective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.

Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.

Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.

Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.
Eating psychopathology and its effect on pregnancy, infant growth and development
Authors: McNicholas Fiona
Published: March 2016

Preoccupation with weight and shape is very prevalent in the female population and is generally well researched. However, the effects of eating psychopathology on infant growth and child development have not been adequately covered and they merit the attention and interest of clinicians. This present submission, using Medline search, critically reviews the available literature and highlights the importance of clinically addressing these issues. It also makes reference to other areas requiring further research. Fifteen articles are discussed which relate specifically to eating psychopathology and the possible effect on mother-child interactions.
A case of Koro in a 20 year old Irish male
Authors: Tobin John
Published: March 2016

A case of classical Koro is described, in a non-Chinese patient having all three symptoms of the syndrome. Of significance is that the patient has a very marked family history for psychotic and affective illness. Also prior to the illness the patient had been under considerable stress, due to his perceived lack of manliness in not providing for his child. The syndrome was associated with impotence, which has been noted as a frequent finding. Also the patient took active physical precautions to prevent further perceived penile retraction, as has been noted in Chinese affected patients.
In search of black bile
Authors: Leonard Brian E
Published: March 2016

Historically Western medicine has been divided into two main schools that were based on the ancient Greek tradition. These are the Hygeian school, based on the views of Hippocrates (born 460 BC), and the Asclepian school which is named after the Greek god of medicine but probably based on the physician Asclepius who was said to have performed miracles!

In brief, the Hygeian school of medicine views health as a natural state of the body. The body is believed to be endowed with inherent healing powers which, if one lives in harmony with these powers, maintains health and helps to restore it should it become impaired. Disease is seen as a manifestation of a weakness of the inherent healing powers of the body and the function of the physician is to help the patients to live within the natural law (vis medicatrix naturae) and to remove impediments to those mechanisms that maintain and restore health.

The second school that has profoundly influenced the development of modern medicine is the Asclepian school which arose in about 1200 BC around the teaching of Asclepius. This school focuses on diseases, their causes and cures. Each disease is considered to be the effect of, or response to, a specific cause that primarily affects a specific organ system. For every disease it is postulated that there is a specific drug or procedure which can alleviate the symptoms or cure the disease. Thus, the successful physician is the one who can make the correct diagnosis and prescribe the correct therapy.
Commentary on litigation and the toxicity of psychotropic drugs
Authors: Casey Patricia
Published: March 2016

What is striking about Leonard's clarion call to the litigants and the legal profession is that he made similar calls over the last number of years, issuing dire predictions of the poor defence a hapless psychiatrist would have in the wake of a completed suicide as a result of an antidepressant overdose, when safer drugs were available. Such a spate of litigation has not followed nor, have the regulatory authorities expressed an interest in the matter. This is simply because a case against a doctor is unlikely to be successful when he or she is acting in accordance with a recognised body of practice within that profession, even though others hold the opposite view, provided of course there is no evidence of overt negligence such as failing to assess current suicidal ideation. Indeed in circumstances where active suicide ideation is present, to only prescribe an antidepressant, even if it were an SSRI, could be deemed negligent if suicide follows since such a patient should be hospitalised.
Factitious post-traumatic stress disorder revisited
Authors: Fear Christopher F
Published: March 2016

Factitious post-traumatic stress disorder, a variant of the psychological Munchausen syndrome, was first recognised in Vietnam war veterans but has not been described since. The case is described of a young man who claimed to have been involved in a fishingdisaster, feigning the symptoms to post-traumatic stress disorder to gain admission to hospital This appears to be a novel presentation of a Munchausen variant which has not been describedin connection with peace time disasters. It would appear that the psychopathology of factitious disorder, like that of other phenomena, such as delusions, is keeping pace with the views ofsocietyand current media concerns. This issue is discussed in the context of a review of recently reported variants of this interesting clinical syndrome.
Acute inpatient admissions in a community oriented old age psychiatry service
Authors: Freyne Aideen , Wrigley Margo
Published: March 2016

Objective: This study reviewed all inpatient admissions in a community oriented old age psychiatry service with the aim of assessing the appropriateness of admission criteria, obtaining a profile of those admitted, and providing information about service utilisation.

Method: A retrospective chart review of all first inpatient admissions from 1989-1993 was carried out. Information concerning sociodemographic and clinical variables, and outcome measures in terms of discharge destination, was obtained.

Results: There were 205 first admissions in the study period. There were 37 patients (18%) admitted on an involuntary basis. One per cent of admissions were not assessed at home prior to admission. Six patients had no formal psychiatric disorder, of the remainder 53% had an organic, and 47% a functional psychiatric disorder. Of those admitted 68% were discharged to their original destination. Patients with dementia were more likely to be discharged to nursing homes. Other discharge destinations were also used.

Conclusions: The policy of initial domiciliary assessment of all referrals prior to admission is feasible in the majority of cases. Defined admission criteria clarify reasons for admission, and ensures appropriate use of beds. The range of discharge destinations highlights the need for maintaining close ongoing links with other service providers.
Trainee attitudes towards their training and its supervision
Authors: Meagher David , Quinn John , O'Mahony Edmond , Morgan Maria , Byrne Peter
Published: March 2016

Objectives: To assess the experience and attitudes of trainees towards a range of aspects of their training in Psychiatry.
Rapid cycling mood disorder: A review
Authors: Healy Elaine , McKeon Patrick
Published: March 2016

Objectives: Rapid cycling mood disorder is an important clinical phenomenon. The concept of rapid cycling has evolved since it was first described in 1974. The purpose of this review is to summarise current diagnostic criteria, postulated risk factors and suggested management strategies.

Method: A Medline and Psych-Lit computerised literature search was supplemented by tracing back through the references from existing review work.

Results: Over 80 papers were identified which discussed diagnosis and management of rapid cycling.

Conclusions: DSM-IV provides a useful but narrow definition of rapid cycling. Standard treatment of affective disorder may exacerbate rapid cycling. If a rapid cycling course develops, discontinuation of antidepressants and use of mood stabilisers is recommended.
Homozygous mutation at cytochrome P4502D6 in an individual with schizophrenia: Implications for antipsychotic drugs, side effects and compliance
Authors: Gill Michael , Hawi Ziarih , Webb Marcus
Published: March 2016

We report the case of a patient with schizophrenia who has suffered severe side effects with many different antipsychotics. She is poorly compliant with treatment probably because of her experiences with medication. We determined her genotype at the CYP2D6 gene that codes for an enzyme principally involved in the metabolism of many antipsychotics. She was homozygous for the ‘B’ mutation, the most frequent of several known mutations. She therefore has no functioning CYP2D6 enzyme in common with 5%-10% of the population. This may explain why she is sensitive to quite moderate doses of antipsychotic medication, and more rational prescribing may lead to fewer side effects and increased compliance.
Brain blood flow abnormalities associated with oral cocaine use
Authors: Johnson Bankole , Lamki Lamk , Barron Bruce , Spiga Ralph , Chen Richard , Meisch Richard , Khilnani Neera
Published: March 2016

Single photon emission tomography (SPECT) is the prototypical tool for measuring cerebral blood flow (CBF) in discrete areas of the brain. Compared with when a male ‘crack’ cocaine user received placebo, oral cocaine (1mg/kg) ingestion was associated with non-uniformity of overall CBF with hypoperfusion of discrete brain regions, particularly of the frontal, temporo-parietal, basal ganglia, and thalamic areas. While these results should be viewed as preliminary, they do suggest that oral cocaine use may be associated with CBF abnormalities in ‘crack’ users.
Salbutamol inhaler abuse and psychosis
Authors: Cotter Paul A
Published: March 2016

A case is described in which a man with asthma and a history of alcohol dependence presented with a paranoid psychosis refractory to standard neuroleptic treatment. Symptomatic improvement was achieved when abuse of salbutamol (Ventolin®) metered dose inhaler was discovered and an alternative β2-agonist delivery system prescribed. A contribution by salbutamol to the psychosis is proposed. It is suggested that increased awareness regarding psychiatric morbidity is needed when metered dose salbutamol inhalers are prescribed.
Clozapine plasma levels and dosing strategies in patients with treatment-refractory schizophrenia
Authors: Buckley Peter F , Cola Philip , Hasegawa Mitsuru , Lys Christine , Thompson Paul
Published: March 2016

Objective: To determine the effect on clinical response to clozapine of increasing the plasma levels of clozapine and its major metabolite N-desmethylclozapine in 19 patients with schizophrenia who had plasma clozapine levels ≤ 370ng/ml, a level previously determined to identify patients who were unlikely to have an adequate response to clozapine.

Method: The dosage of clozapine was increased by 20% in 11 patients and left unaltered in the other eight patients. Clozapine and N-desmethylclozapine plasma levels were measured after six weeks at the higher dose.

Results: Nine of the 11 patients in whom clozapine dosage was increased subsequently achieved plasma clozapine levels ≥ 370ng/ml. However, in this group of patients who already had partially responded to clozapine, increasing the dosage of clozapine did not produce additional clinical improvement.

Conclusion: Clozapine plasma levels are useful in clinical practice to guide dosage strategies. However, these results suggest that increasing the dosage of clozapine to achieve plasma levels ≥ 370ng/ml is unlikely to produce further improvement in patients who have already achieved a partial response to clozapine at plasma levels ≤ 370ng/ml.
Where to? A survey of the residual population of a district mental hospital and their predicted placement needs
Authors: Smyth Ciaran , Mohan Angela , Buckley Con , Clarke Anna
Published: March 2016

Objective: In line with Irish government and health board policy, existing district psychiatric hospitals are scheduled for rundown and closure, with ongoing care being transferred to general hospitals and community based resources. However it is unclear as to what resources will be required if this policy is to proceed. The objective of this study is to obtain the current needs profile of the inpatient population of one such hospital and to predict what facilities would be needed in the event of closure.

Method: Using a staff completed questionnaire, specially constructed by the hospital rehabilitation team, and which has been used to help predict needs for past successful relocations, information was obtained on all inpatients on a designated day. Each patient was rated as requiring independent, low-support, or high-support accommodation, the nature of which depending on the perceived needs.

Results: This survey shows that the residual population is predominantly middle-aged and elderly with many disabilities and persisting challenging behaviours. The majority have high dependency needs which limits the placements options to high support facilities, which as yet are under provided for in the community.

Conclusion: Further planning and resources will be required if the above policy is to be realised.
A survey of psychotropic drug use in elderly psychiatric inpatients
Authors: Loane Ruth , McGauran Sheila , Buckley Con , Howell Fenton , Johnson Zachary , Mohan Angela
Published: March 2016

Objective: The objective of the present study was to examine the use of medication in an elderly psychiatric inpatient population.

Method: This was a retrospective survey of medication prescribed to the total elderly inpatient population of a single psychiatric hospital. Data collected included basic sociodemographic information, length of stay, number of admissions, frequency of psychiatric disturbance, diagnosis and medication prescribed.

Results: A total of 340 cases were studied, 229 (67%) were female, 324 (95%) had been inpatients for more than one year, 111 (33%) suffered from dementia, while the remainder were in the functional category. In 57% more than one psychotropic drug was used. Over half (56%) of those with dementia were on neuroleptic medication.

Conclusion: Psychotropic polypharmacy was found in this population of elderly patients. Management issues emphasised include the risk of polypharmacy in this age group, the need for staff education, an active pharmacy committee and alternative methods of managing behavioural disturbance in elderly patients in particular those with dementia.
Object relations theory applied to early emotional deprivation, resulting in autistic spectrum disorder
Authors: Rooney Siobhan , Byrne Gerard
Published: March 2016

Objective: The following case report describes a child with autistic symptoms who experienced early emotional deprivation and institutionalisation. The paper discusses her symptoms in relation to Melanie Klein's theories on object relationships.

Method: LM was a four year old Rumanian adoptee, when she was first assessed by a child service in Dublin. On presentation, she exhibited a spectrum of autistic symptoms including an impairment in social interaction, absence of separation anxiety, poor attachment formation with others and restricted, repetitive, stereotyped patterns of behaviour. While attending the pre-school, she was involved in an individualised programme which focused on her specific needs.

Result: After attending the pre-school programme, L exhibited a greater ability to express various emotions and her social interaction with others had improved, but she continued to have marked deficits in her personality. This child's symptoms are discussed with reference to the paranoid schizoid and depressive positions associated with ego development.

Conclusion: By applying Melanie Klein's theories on object relations, one can gain a further understanding of a child's pathological symptoms, ego development and the necessary treatments required to improve these symptoms.
Reintroduction of antipsychotics in a patient with clozapine induced neuroleptic malignant syndrome
Authors: Williams Kelwyn , MacPherson Rob
Published: March 2016

We report a case of neuroleptic malignant syndrome (NMS) secondary to clozapine treatment in which re-introduction of two different antipsychotics led to elevation of creatinine kinase (CK) levels without associated symptoms of NMS. The significance of CK levels as a marker for NM S is discussed in the light of previous findings in this area. We suggest clinical guidelines for antipsychotic rechallenge after the occurrence of NMS.
Hypertension and increased serum clozapine associated with clozapine and fluoxetine in combination
Authors: Sloan Darina , O'Boyle James
Published: March 2016

We report the case of a patient with schizophrenia who demonstrated increased serum clozapine and norclozapine levels in association with hypertension, when treated with fluoxetine and clozapine in combination.
Driving, mental illness and the role of the psychiatrist
Authors: Elwood Peter
Published: March 2016

Objectives: Drivers with certain mental illnesses are obliged by the Driver & Vehicle Licensing Authority (DVLA) to stop driving and to report their condition. This study aims to quantify the number of psychiatric patients failing to meet the DVLA standards of ‘fitness to drive’ and to record how frequently psychiatrists failed to advise patients of these standards.

Method: In this prospective descriptive study, 10 psychiatrists reported by questionnaire the diagnosis and driving status of all patients encountered over a four week period. They recorded their advice given to patients failing to meet the DVLA criteria of ‘fitness to drive’ and advice given when prescribing psychotropic medication.

Results: Of 297 patients, 123 (41%) were drivers. 19/123 (13%) of drivers failed to meet the DVLA standards of ‘fitness to drive’. In 9/19 of these cases the psychiatrist did not advise the patient in line with the DVLA guidelines. This was especially the case for alcohol related disorders. Of drivers 49% were prescribed psychotropic medication with potential adverse effects on driving.

Conclusions: Driving amongst mentally ill patients appears commonplace. In this study, 13% of drivers were considered by the authorities to be unfit to drive. Psychiatrists frequently used their own judgement when advising patients regarding driving. This arguably contravenes doctors' responsibilities to patients and has potential legal implications for both the patient and psychiatrist.
Coprophagia in association with depression and hypothyroidism
Authors: Nicholls KR , Ananthanarayanan TS
Published: March 2016

Coprophagia is a disturbing behaviour sometimes associated with mental disorder in humans which is poorly described and understood. We describe a case of hypothyroidism and depressive psychosis, associated with coprophagia which resolved with treatment. Further examination of this phenomenon and its relationship with underlying endocrine and psychotic disorder is required.
Neuroleptic induced polydipsia and hyperphagia in an adult with learning disability
Authors: Graham Candida , Jawed Syed Hasan
Published: March 2016

This case report is of a young male with learning disability, who presented with long-term polydipsia and hyperphagia. The patient's polydipsia and hyperphagia showed a correlation with long-term use of neuroleptics for behavioural problems. Withdrawal of all neuroleptic medication resulted in an immediate improvement in both the polydipsia and hyperphagia leading to a complete resolution of both symptoms. While neuroleptics are a recognised cause of polydipsia, hyperphagia is less frequently described and we believe this to be the first report in which a patient is observed to have polydipsia and hyperphagia induced by neuroleptics. We discuss the possible aetiological mechanisms for both polydipsia and hyperphagia and conclude that the basic pathophysiology in our case appears to be a neuroleptic induced malfunction of the satiety centre due to blockage of dopamine receptors in the ventromedial hypothalamus.
Psychiatric training in New Zealand – opportunities for Irish trainees
Authors: Mulholland Ciaran
Published: March 2016

A period of psychiatric training in New Zealand is relatively easy to organise and provides opportunities not available locally. This article illustrates some of the similarities and differences between Irish and New Zealand psychiatry and provides advice on how to arrange a placement.
Psychiatric presentation of frontal meningiomas
Authors: Fahy Sabina T , Carey Teresa G , Owens John M , Owens Anthony P
Published: March 2016

Patients with frontal lobe meningioma may present to psychiatric services. Clinical diagnostic sensitivity, particularly in the absence of neurological signs, remains central to diagnosis.
Neuroleptic induced blepharospasm and its treatment with botulinum toxin type A
Authors: Rampes Hagen , Patel Ashok G
Published: March 2016

Three cases of neuroleptic induced blepharospasm successfully treated by botulinum toxin type A are reported.
Nicotine patches and paranoid psychosis
Authors: Marston Geoffrey Michael , Cormac Irene Dove
Published: March 2016

A patient was admitted with an acute paranoid psychosis. Prior to her illness, she had been using Nicobate patches while still smoking. The relationship between the two are discussed.
Recent developments in the genetics of schizophrenia
Authors: Murphy Kieran C , Gill Michael
Published: March 2016

Objectives:To examine the evidence concerning the recent developments in the genetics of schizophrenia.

Methods:An extensive literature search was performed and relevant papers were examined and analysed.

Findings:There is overwhelming evidence that schizophrenia shows familial aggregation. Recent molecular genetic studies support the presence of susceptibility genes on chromosomes 6 and 22. In addition, an association between schizophrenia, the dopamine D3 receptor gene and the 5-HT2areceptor gene has also been demonstrated.

Conclusions:Recent advances in DNA technology have paved the way for the detection of genes of major and minor effects in the aetiology of schizophrenia. If the presence of the recently identified susceptibility genes is confirmed, it is likely that these genes will be recognised in the near future.
Suicide: Some ethical implications
Authors: Kelleher Michael J
Published: March 2016

Death faces us all. Preoccupation with it however is commonly regarded as morbid. As a way of dying, suicide is seen as being abnormal. This is certainly so in a statistical sense. In 1993, there were 31,896 deaths in the Republic of Ireland of which officially 357 were suicides. This means that approximately one in a hundred deaths today are self-inflicted. The proportion of suicide deaths to other deaths varies across age groups, however. Generally speaking among the young, suicide is a more common cause of death because other types of death are less common. In the past the official Irish suicide figures may have under-estimated the true picture. Recent research however has shown that the official Irish suicide statistics are likely not to underestimate the true rate and are also more likely to be reliable than are the equivalent statistics from England and Wales.

The word ‘abnormal’, however, in medicine is also used in a nonstatistical sense to imply deviation from the ideal or desirable. If we say someone is abnormal, we imply that he is either mentally ill or suffering from a defect or blemish of personality. Most people assume that those who intentionally end their lives are abnormal in this latter medical sense, immediately prior to death. The opposite holds in murder. Society assumes the perpetrator is not mentally ill unless evidence is brought forward to the contrary. Not all believe this, however, and some actively canvass the viewpoint that suicide, in certain circumstances, is to be encouraged.
Asymptomatic tricyclic toxicity associated with diltiazem
Authors: Cotter Paul A , Raven Peter W , Hudson Marina
Published: March 2016

Therapeutic drug monitoring of tricyclic antidepressants is a controversial issue. A case is reported in which a patient with recurrent depression developed asymptomatic tricyclic toxicity while on trimipramine, a tricyclic antidepressant, and diltiazem, a calcium channel blocker. A metabolic interaction involving cytochrome P450 3A (CYP3A) is postulated. It is suggested that routine therapeutic drug monitoring of tricyclic levels should be an essential part of the management of depression.
The relationship between maternal depression (antenatal and pre-school stage) and childhood behavioural problems
Authors: Mohan Damian , Fitzgerald Michael , Collins Claire
Published: March 2016

Objective: This study aims to determine if there is a relationship between antenatal depression and maternal depression in the following three to four years. Secondly, to establish if there is a relationship between maternal depression and behavioural problems with the pre-school child. Thirdly, to investigate if social parameters are correlated with maternal health and childhood behaviour.

Method: In a longitudinal study, a sample of women were screened for depression at the antenatal stage and followed up four years later. Mothers were screened for depressive illness on both occasions. Children's behaviour was assessed at four years. Social parameters were also measured at the pre-school stage.

Result: Depression at the antenatal stage was not found to be significantly related to depression at the pre-school stage. The existence of a behaviour problem was not significantly related to the depressive state of the mother antenatally, however a currently depressed mother is approximately six times more likely to have a child with behaviour problems than a mother who is not depressed. Social factors were also assessed and found to correlate with maternal depression.

Conclusion: In managing a child with behavioural problems the child psychiatrist should consider the mental state of the mother. The social world of the individual would appear to be important and should not be ignored when treating either a child with behavioural problems or an adult with depression.
Social skills correlates of depressed mood in normal young adolescents
Authors: Garland Malcolm , Fitzgerald Michael
Published: March 2016

Objective: To explore the relationship between social skills and depressive symptoms in a normal young adolescent population.

Method: An all male group of 85 schoolchildren, in the first year of secondary school, completed self-report instruments to measure the constructs of depression and of social skills. The Depression Self-Rating Scale (DSRS) and the Matson Evaluation of Social Skills with Youngsters (MESSY) were the instruments used.

Result. Regression analysis of the factor scores on the MESSY and the total score on the DSRS revealed a significant, negative relationship. This was particularly so for the jealousy/withdrawal factor (Factor V) on the MESSY (f = 27.323; p < 0.001)

Conclusion: The data provide support for the social skills deficit model of depression and indicate the possible role of fostering pro-social behaviours and promoting social skills enhancement in the vulnerable young adolescent.
Contemporary psychosurgery: indications, outcome and the Irish experience
Authors: O'Doherty Miriam , Bridges Paul K
Published: March 2016

Objectives: To review recent use of psychosurgery in Britain and Ireland; to outline the indications and contraindications; and to summarise the Irish experience of psychosurgery.

Method: The Geoffrey Knight National Unit for Affective Disorders (GKU), now based at the Maudsley Hospital has performed the largest number of psychosurgical operations in the last 30 years. This paper reviews criteria for referral and outcome of stereotactic subcaudate tractotomy at the GKU. The twenty-one referrals from Ireland to the Unit, resulting in eight operations over the fifteen year period 1981-1995, are considered separately.

Results: The efficacy of stereotactic subcaudate tractotomy is of the order of 30-60% and there is a low incidence of long-term adverse effects. The outcome of the eight Irish patients who underwent psychosurgery compare favourably with the overall outcome figures for the Unit.

Conclusions: Stereotactic subcaudate tractotomy remains a treatment of last resort in the rare cases of severely treatment-resistant affective disorders and obsessive compulsive disorders.
Dr Michael Kelleher (1938-1998)
Authors: Webb Marcus
Published: March 2016

Psychiatrists throughout Ireland lost a valued and respected colleague when Michael Kelleher died on the 9th August 1998. It is unusual for a doctor and certainly for a psychiatrist to receive widespread tributes in the national as well as the professional press, and these have borne eloquent witness to Michael's qualities as a man and to his achievements as a psychiatrist.

Dr Kelleher's major achievements have been well recorded: they particularly concern his research in Cork on suicide in the latter decades of the 20th century. This interest arose from his work with a post-graduate student, Dr Maura Daly, in the early 1980s. They identified the rising suicide rate, especially amongst the young, and set about understanding the phenomena they carefully observed. Having provided evidence that improved official reporting of suicide was not a sufficient cause of the rising rate, Dr Kelleher moved on to focus on unemployment, the availability of medicines, substance abuse and the rapid changes in Irish society in seeking to explain these disturbing trends. His writing was careful and considered and he maintained a consistently high standard of scholarship. This is clearly evident in his editorial “Youth suicide trends in the Republic of Ireland” for the British Journal of Psychiatry, published posthumously in September 1998. In latter years his voice became familiar in the media when he was always lucid and cautionary, while strongly advocating measures to improve Ireland's mental health.
Empirical investigation into placebo effectiveness
Authors: Dolinska Barbara
Published: March 2016

Objectives: To investigate whether placebo effects may vary in strength, depending on appearance of the medication.

Method: Polish subjects were randomly given different kinds of pills and told that the medicine was produced abroad or in Poland and that it was cheap or very expensive. Measures of different forms of well-being were taken directly after the ‘therapy’.

Results: Subjective ratings were higher for subjects who received big white or small red medicine compared to subjects who received small white or big red pills. The results are discussed in the light of the subject's previous experience with drugs of different kinds.

Conclusion: It was shown that placebo effects do vary in strength, depending on the appearance of the pill.
Management advice for children with chronic fatigue syndrome: a systematic study of information from the internet
Authors: Wright Barry , Williams Christine , Partridge Ian
Published: March 2016

Objectives:Parents often present practising clinicians who see children with chronic fatigue syndrome with printouts from the internet. These are then brought into the discussion about the management and aetiology of this debilitating condition. We set out to systematically study the information on the internet on this subject and to explore the diversity of advice in relation to current research knowledge.

Method:Systematic search by means of the internet browser Netscape Navigator and search engines AltaVista and Yahoo! Advice about levels of rest, exercise, medication, psychological interventions and suggestions about return to school is critically compared with current research evidence.

Results:Thirteen websites were accessed. All have some treatment advice. Six offer conflicting advice about levels of rest, with two suggesting large amounts of rest, two suggesting some rest and two suggesting graded exercise. Nine suggest medications (with a wide variety of pharmacological activities) despite the lack of research evidence showing a significant contribution from medication. Four suggest psychological treatments but some advise that it is unnecessary despite the established evidence in chronic fatigue (and other chronic illnesses) that appropriate psychological treatments are helpful. There are a wide variety of differing diets recommended.

Conclusions:Few websites provide useful management advice. Advice offered is often in conflict. Some of the advice is either contrary to current research evidence or not supported by it. This raises concerns about inaccurate information reaching families who have a child with chronic fatigue syndrome, with potentially damaging consequences. This suggests a need for a debate about the availability and validation of health related information on the internet.
The views of professional on the role of self-help groups in the mental health area
Authors: Dunn Elizabeth A , Fitzpatric Aine C
Published: March 2016

Objectives:Changes in healthcare policy over the last decade emphasise care in the community over residential care. Self-help organisations may play a useful role in these circumstances. Against this background, the objective of this study was to obtain the views of members of the main mental health professions on the place of self-help groups in mental health care.

Method:A postal survey of 255 mental health professionals from two health boards was carried out, using a semi-structured questionnaire that contained both open and closed questions. The responses obtained were analysed using descriptive statistics and content analysis as appropriate.

Results:The response rate was 35% so results must be interpreted cautiously. Self-help groups are used particularly in the management of addictive behaviours, and are also considered useful in cases of mood disorder. In general, self-help organisations are seen as providing support to patients and their families; information on mental illness/health to the general public; and lobbying for services relevant to the needs of their members. Respondents were concerned that the philosophy and programme of a group should not conflict with established models of mental health. The impact of the organisational structure of the multi-disciplinary team on the referral pattern of the different mental health professions, and the role of group availability and accessibility on the decision to refer a patient to a self-help group is commented upon.

Conclusions:While some professionals see a role for self-help organisations in the mental health care system, reservations expressed about a possible clash between selfhelp groups' approach and professional mental healthcare practice need to be addressed so that the potential of both positions can be realised.
Towards mental hospital closure – a study of a residual long-stay population
Authors: Farragher Barbara , Fahy Sabina , Carey Teresa , Owens John
Published: March 2016

Objectives: To describe an entire long-stay hospita population and examine the differences between the old and new long-stay groups. It outlines the communitybased facilities required for hospital closure to occur.

Method: One hundred and twenty-four patients were assessed using the Community Placement Questionnaire (CPQ), a standardised instrument used in service planning.

Results: The CPQ revealed a globally disabled group with multiple handicaps. The mean age was 68.7 years and the predominant diagnosis was schizophrenia. Though the old long-stay (74) were more disabled than the new long-stay (50), similar sheltered accommodation was required for both groups. The new long-stay required a more active day-care program.

Conclusions: Reprovision for long-stay patients must not only include sheltered accommodation but also appropriate day-care facilities. Assessment of the placement needs of all categories of long-stay patients necessary before hospital closure can take place.