bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring the physical health of individuals with serious mental illness
Authors: Cahill Majella , Jackson Anne
Published: March 2016

Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring.
Risk stratification and the care pathway
Authors: Pillay Selena M , Oliver Brid , Butler Louise , Kennedy Harry G
Published: March 2016

Objectives: It was hypothesised that patients admitted to forensic mental health facilities are stratified along the pathway through care according to levels of need. Level of risk and psychopathology should vary with different levels of security.

Method: Seventy-five men in a forensic hospital were interviewed by three trained clinicians using the HCR-20 (Historical Clinical Risk Assessment) – clinical and risk items, The Health of the Nation Scales – Secure (HoNOS-SECURE), PANSS (Positive and Negative Syndrome Scale), GAF (Global Assessment of Functioning) and the CANFOR (Camberwell Assessment of need Forensic Version).

Results: The mean scores on a variety of clinical measures were higher in admission/high security areas and progressively lower in rehabilitation and pre-discharge areas. As patients moved through the pathways of care, they improved in a number of areas including psychiatric morbidity, risk, function, unmet needs. The following results stratified significantly; the HCR-20 summated clinical and risk (F = 9.2, df = 5, p < 0.001), the HoNOS secure (F = 18.2, df = 5, p < 0.001), PANSS (positive, general and total), GAF, staff and user unmet needs on the CANFOR.

Conclusions: The data indicate that the theoretical organisation of the units of the hospital into high, medium and low security units to form a coherent pathway through care is reflected in practice. This is a transparent route out of secure care in which restrictions are proportionate to risk and supports proportionate to need. It is unclear whether alternative models, consisting of a series of generic unstratified units for admission and discharge, all at the same level of therapeutic security, allow for the provision of treatment programmes and relational interventions appropriate to the patient's stage of recovery and rehabilitation.
Staff attitudes towards particular client difficulties in assertive outreach teams
Authors: Jones Rowena , McGovern Dermot , Reading Bethan
Published: March 2016

Objective:Over recent years in England there has been widespread development of assertive outreach teams supporting patients with severe mental illness living in the community. Assertive outreach staff members are exposed to a variety of new stressors and risks. This study investigated the emotional impact on keyworkers of working with assertive outreach patients. This was considered in terms of the attitudes keyworkers hold towards patients with particular types of difficulty. The study also measured individual keyworker stress.

Methods:Keyworkers from three teams in Birmingham were surveyed regarding their attitudes towards individual patients. Questionnaires measuring attitudes and patient difficulties were derived for the purpose of the study. Strengths of attitudes were correlated against different patient difficulties. Keyworker stress was measured using the General Health Questionnaire, GHQ12.

Results:Certain patient difficulties, in particular poor engagement, psychotic symptoms and aggression were associated with feelings of failure in keyworkers whilst drug use, particularly crack cocaine use, was associated with fear of visiting patients at home. Some 41% of keyworkers met ‘caseness’ criteria on the GHQ12. Negative attitudes appeared to be independent of GHQ scores.

Conclusions:Keyworkers expressed a number of positive and negative attitudes in relation to patient difficulties. Negative attitudes did not appear to be simply a feature of keyworker stress, however it is acknowledged that the sample size was small. Keyworkers' responses suggested a sense of personal failure when their patients were unwell or poorly engaged, despite patients being selected for assertive outreach on the basis of such difficulties. Recognition of negative attitudes may help in the improvement of training and supervision of staff members.
Internal audit of attendances at a psychiatry outpatient clinic
Authors: Kelly Brendan D
Published: March 2016

Objective: This audit aimed to (a) systematically identify problems related to rates of attendance and non-attendance at one psychiatry outpatient clinic; (b) quantify these problems; (c) implement strategies to improve service delivery; and (d) re-audit after three months.

Methods: Specific standards were set in relation to patterns of attendance at the outpatient clinic. Audit was performed over two weeks; changes to practice were agreed and implemented for three months; re-audit was performed.

Results: The initial audit showed that (a) 93 people attended the clinic over two mornings with a non-attendance rate of 13.9%; (b) 30.1% of individuals who attended did not have an appointment; (c) 20.4% of attendances were ‘inappropriate’; (d) 2.2% did not live in the clinic's catchment area. Based on these results, the clinic introduced a protocol for individuals who attended without appointment; a protocol for streamlining the provision of prescriptions; and a renewed emphasis on transferring the care of individuals not residing in the catchment area. Three months later, re-audit showed that (a) the number attending over two mornings decreased from 93 to 43, but the non-attendance rate had not changed; (b) the proportion of individuals presenting without an appointment (9.3%) decreased significantly compared to the initial audit (30.1 %); (c) the proportion of ‘inappropriate’ attendances (9.3%) tended to decrease compared to the initial audit (20.4%) but this was not statistically significant; (d) there was no difference in the proportion of patients who did not live in the catchment area; these proportions were low in both the initial audit (2.2%) and re-audit (2.3%).

Conclusions: A relatively simple audit such as this can result in a more efficient and appropriate delivery of outpatient mental health services. On this basis, there is a need to provide ongoing resources for further cycles of clinical audit in mental health services.
Primary progressive aphasia presenting as possible conversion disorder
Authors: Ademola Foluso , Brophy Jennifer , Oguntade John , Murphy Denis
Published: March 2016

We describe a case of primary progressive aphasia (PPA) in a 62 year old right handed Irish woman who had progressive speech and language difficulty over a period of six years. She continued to work for a remarkable length of time and lived independently managing all her activities of daily living. The case posed a diagnostic challenge because initial presentation was suggestive of a conversion disorder. She also displayed signs and symptoms which overlapped with a fronto-temporal dementia and possibly early Alzheimer's disease. In our discussion, we explore the possible reasons for this overlap and the implication for psychiatrists. The need for adequate and sensitive investigations and a multi-disciplinary approach cannot be overemphasised as PPA cases are easily missed depending on the stage at which the patient presents.
Drug combination with bupropion: a case of southern comforts
Authors: Domhnaill Seàn Ó
Published: March 2016

A patient with a 20-year history of dysthymia had been treated with a range of anti-depressants over a period of two decades. He had experienced no clinically significant symptomatic relief for 14 years until he was recommenced on fluoxetine, a drug which had been of limited benefit to him previously. He showed no improvement in motivation, chronic anergia or easy fatiguability. He commenced an anti-smoking agent, bupropion hydrochloride (Zyban), without informing his treating psychiatrist and following the manufacturers' instructions, took the drug for four weeks, while initially continuing to smoke. He failed to discontinue smoking. However, his energy, motivation and general sense of wellbeing improved markedly, to the extent that his friends and colleagues commented upon the change.

Bupropion hydrochloride is a well-known anti-depressant agent not currently licensed for use in Ireland. His combination of fluoxetine and bupropion has improved his functioning to its best level in 20 years. The improvement has been sustained for over six months. We examine the issues raised by this unusual combination, which I have termed ‘southern comfort’, in recognition of its geographical site of clinical impact.
The lunatic asylums of Ireland 1825-1839
Authors: Walsh Dermot
Published: March 2016

Objectives: By the early 19th century the social manifestations of psychiatric disorder had become a matter of public and parliamentary pre-occupation in Ireland. This concern led to legislative provision for the establishment of a national system of district lunatic asylums. This paper describes some details of the early foundation of this system.

Method: Examination of House of Commons papers on the lunatic asylums of Ireland 1835-1839.

Results: Details are presented concerning the activities, numbers of residents, admissions and costs of the 11 asylums in operation by 1839.

Conclusions: By 1839 the operational, administrative and cultural characteristics of a national asylum system that would take another half century to complete and would extend well into the 20th century had been established.
Informed consent in psychiatric practice: where does the law now stand?
Authors: Leonard Peter
Published: March 2016

There is an established ethical and legal duty upon psychiatrists to obtain informed consent before treating a patient, although some exceptions do apply under Mental Health Legislation. The required standard for informed consent has been the subject of important case law in Ireland and other common law jurisdictions and this has caused some uncertainty for clinicians. The standard of informed consent can be viewed from the point of view of what the medical profession thinks is appropriate, or alternatively from the position of what a patient would reasonably expect to be told. These contrasting approaches are discussed in detail. A recent decision of the Irish Supreme Court establishes the ‘patient-centred’ standard for informed consent as the relevant standard in Irish law. The current legal position on informed consent is discussed in relation to common clinical scenarios in psychiatric practice.
Hypoprolactinaemic galactorrhoea in long-term methadone treatment
Authors: Uhoegbu Chimdi , Doran Michael , O'Connor John
Published: March 2016

Although hyperprolactinaemia is associated with galactorrhoea, galactorrhoea often occurs without any hyperprolactinaemia. This has been well established, and it has been documented in women prescribed/using methadone and other opiates. One case series described amenorrhoea and galactorrhoea in ‘female heroin addicts’, but it has not before been described in a patient with hypoprolactinaemia.

We report a case of a 30 year old non-pregnant, non-puerperal, opioid-dependent, HIV positive woman on long-term methadone maintenance programme, who presented with bilateral, milky nipple discharge, associated with painful breast lumps, but with serum prolactin levels below the normal range. She was not prescribed any other medications likely to have effect on the endocrine system. This case highlights the need for prescribers to be alert to the implications of long-term use of opioids.
Attitudes of consultants to prescribing ECT for patients involuntarily admitted under MHA 2001
Authors: Schirliu Diana , Truszkowska Edyta , McDonald Colm
Published: March 2016

Objectives: The Mental Health Act (MHA) 2001 provides the legislative structure in Ireland for the involuntary admission and treatment, including with ECT, of patients suffering from mental disorders. A recent Seanad Bill proposed removing the option of administering ECT to involuntary patients who do not provide informed consent. This controversial issue has stimulated extensive media and stakeholder debate. In this study we explored the attitudes of consultant psychiatrists towards prescribing ECT for involuntary patients.

Methods: We compiled a current list of consultant psychiatrists attached to approved centres nationwide. We sent a study specific questionnaire to consultants of all adult psychiatry specialties.

Results: From the 249 individualised anonymous questionnaires posted, 164 (66%) were returned and analysed. When clinically indicated for involuntary patients willing to consent to ECT treatment, 159 (97%) consultants stated that they would and three (2%) would not prescribe ECT. For involuntary patients who lack capacity and are unable to consent, 157 (96%) consultant psychiatrists stated that they would and six (4%) that they would not prescribe ECT. For involuntary patients who have capacity to consent but are unwilling to do so, 52 (32%) consultant psychiatrists stated they would and 104 (63%) would not prescribe ECT.

Conclusions: The overwhelming majority of consultant psychiatrists would prescribe ECT for involuntary patients who are unable to consent to this treatment. Divergent attitudes emerged for treating patients who are unwilling to consent, with most consultant psychiatrists stating they would not prescribe ECT for this patient group.
Prevalence of substance misuse comorbidity in an Irish university training hospital
Authors: Dixit Ajay , Payne Ann
Published: March 2016

Objective: Substance misuse complicates an individual's management in adult Mental Health services. This study aimed to examine both the overall prevalence of substance misuse in those admitted to the psychiatric unit and additionally those admitted with a primary diagnosis and comorbid substance misuse. The study focuses on the associated diagnoses and demographics in 100 consecutive admissions to an acute psychiatric unit in an Irish university hospital.

Method: Clinical notes were reviewed independently by two members (one being a doctor), of the multi-professional research team within four days of their admission. Substance misuse proximal to the/at the time of admission (reflecting the current usage) was noted.

Results: The combined prevalence of mental illness and substance misuse was 47% (CI 37-57%). Twenty two out of 100 (22%, CI 14-32%) were admitted primarily for the management of substance misuse and dependence (plus psychosocial reasons). Twenty-five of the patients admitted with a primary psychiatric illness (25%, CI 17-31%) were discovered to have comorbid substance misuse. At risk groups were found to be males and aged under 45 years.

Conclusion: Our study demonstrates the importance of screening and identification for substance misuse in psychiatric inpatient units; and consequently, the need for individual case management, additional development of dual diagnosis services and accurate patient data reporting to facilitate forward service-planning.
Audit of documentation of allergies in a psychiatric inpatient unit
Authors: Eneh Oliaku , Fahy Sabina
Published: March 2016

Objectives: This audit aimed to: identify the level of allergy documentation in admission notes, case notes and medication charts in the Department of Psychiatry, Portlaoise; establish the degree of compliance to the gold standard guidelines; highlight areas requiring further improvement and make realistic recommendations to ensure better compliance with the stipulated guidelines on allergy documentation; and re-audit after six months.

Methods: Gold standard guidelines on allergy documentation were obtained from various sources. Audit was performed over three days during which data was collected from the allergy section of medication charts, current case notes and original admission notes in both acute and long-stay wards. Recommendations were made and some were adopted, changes to practice were implemented for six months; at which time re-audit was performed.

Results: The initial audit revealed that: the allergy section was completed in 25% of medication charts; only 12% of current case notes had any documentation of allergy status; an for the original admission notes, the allergy section was documented in 65% of notes. Based on these results, a formal initial assessment proforma with a designated allergy section was introduced and a renewed awareness of the importance of the documentation of allergy status was actively promoted amongst non consultant hospital doctors (NCHDs). Six months later, re-audit showed that: in the medication charts there was a significant improvement in the level of compliance with documentation of allergy status (allergy or NKDA) in the allergy section up from 25% to 58.1%; in the current case notes, there was only marginal improvement in the level of compliance on the front of case notes from 12-19.1%; and in the original admission notes, there was also considerable improvement in the level of compliance with documentation of allergy status up from 65% to 80.9%.

Conclusion: This audit improved the level of documentation of allergy sections in the relevant areas and therefore helped in preventing avoidable and potentially fatal allergic reactions. It will also help save money for the Health Service Executive by reducing compensation costs filed by patients.
Cognitive remediation therapy for schizophrenia: what is it and does it work?
Authors: Donohoe Gary , Schmidt Heike , Robertson Ian H
Published: March 2016

Impaired cognition is a core feature of schizophrenia (SZ) that precedes, accompanies, and often outlasts a patient's clinical symptoms. The success of new generation antipsychotics, as well as their failure to ameliorate the persistent disabilities associated with the disorder are well documented. Consequently, a number of psychosocial and cognitive interventions have been developed to address specific aspects of disability not adequately alleviated by medication.

Among these, interventions adapted from the acquired brain literature that target cognitively based disability (cognitive remediation therapy; CRT) have received significant empirical support both for ameliorating specific deficits in memory, attention and executive function, and improving real world outcome. CRT strategies have focused either on providing drill-based training aimed at increasing capacity or providing behavioural strategies for compensating for cognitive deficits, or a mixture of both. Nonetheless, these interventions have varied widely and several questions remain.

This review provides a brief overview of cognitive remediation therapies in psychosis, discusses evidence for its success, and outlines a number of questions that remain about its implementation. Given the current unavailability of cognitive remediation as part of standard care in Irish mental health services, we conclude by describing one such intervention developed within our clinical research group and the questions we hope to address in making this programme more widely available to Irish patients.
Anxiety and depression among opiate users who misuse substances during treatment
Authors: Stapleton Robert , Comiskey Catherine
Published: March 2016

Objectives: While treatment is known to improve drug and crime outcomes for opiate users, there is debate in the literature about the longitudinal effects of substance misuse and the comorbidity of mental health problems. We sought to describe and model anxiety and depression outcomes during opiate substance misuse treatment.

Methods: The first national, longitudinal treatment outcome study of 404 opiate users entering a new episode of inpatient or outpatient treatment and followed up at one and three years and assessed using the Maudsley Addiction Profile instrument.

Results: A total of 404 opiate users were recruited representing approximately 8.2% of all new treatments and 17% of all new methadone treatments at national level in Ireland in 2003. At three years 97% (n = 392) were followed-up. At one year, analysis revealed the odds of experiencing depression was between five and 15 times the odds for opiate users who also used cocaine than non cocaine using opiate users, but this had decreased at three years. At three years those who were drug free, that is, not in treatment and not using illicit drugs, were less likely to experience feeling hopeless about the future than those in treatment or those not in treatment and using, but they were also more likely to experience feeling tense. Those in treatment were more likely to feel lonely.

Conclusion: The concurrent misuse of cocaine and other substances during opiate treatment and the stage of the treatment pathway are associated with anxiety and depression among opiate users in treatment. These client factors need to be considered when implementing individualised treatment care plans.
Users' experiences of cathinones sold in head shops and online
Authors: O'Reilly Fiona , McAuliffe Ruardhi , Long Jean
Published: March 2016

Objective: We describe use and effects of head shop powders among opiate dependant polydrug users and recreational drug users. These powders contain cathinones and were sold as bath salts or plant food via the internet or in head shops.

Method: As this is a relatively new phenomenon, a qualitative approach using three data sources, in-depth interviews, a focus group (containing 10 opiate users) and a head shop website containing 49 product reviews, was employed. Themes were identified.

Results: According to the study population, these powders mimic the effects of cocaine, ecstasy and amphetamines. These substances were snorted, ingested or injected by people and were not used as bath salts or plant food. The users' experience indicates that these powders have the potential for dependence, and exhibit side effects such as insomnia, anxiety and other mental health effects. The users report that the effects of the substances vary over time indicating that the chemical contents of the powders may change.

Conclusion: Though users' descriptions of effects varied, there were indications of health and dependency effects which were more severe and more common among problematic opiate users, who also experienced increased social vulnerability. In general the recreational drug users considered their side effects to be mild and worth the drug induced experience.
Counter-urbanisation during Ireland's ‘Celtic Tiger’ period – mental health implications
Authors: Owoeye Olabisi , Khawaja Manzar , Kinsella Anthony , Russell Vincent
Published: March 2016

Objectives: This study (a) describes the clinical and demographic profile of urban to rural migrants attending a psychiatric outpatient clinic and (b) explores the impact of the move on patients' mental health and lifestyle.

Methods: A self-rated questionnaire distributed to 207 consecutive outpatients requested demographic and clinical information from migrant and non-migrant patients. A focus group study among a purposeful sample of 10 migrant patients explored participants perceptions of the move and its impact on mental health.

Results: One hundred and one patients (48.8%) returned the questionnaire. Most migrant responders described housing affordability as influencing their decision and were generally satisfied with the move. However, half reported reduced access to social amenities. Over half of the migrant outpatients had a previous psychiatric history and were mostly unemployed despite being home-owners. Predominant focus group themes included the perceived need to leave the city for the relative safety and calm of rural living as well as post-migration concerns regarding future isolation and diminished levels of support.

Conclusion: Clinicians and service providers in rural areas should be informed by an awareness of the potential mental health implications of counter-urbanisation.
Sharing control: user involvement in general practice based methadone maintenance
Authors: O'Reilly Fiona , O'Connell David , O'Carroll Austin , Whitford David L , Long Jean
Published: March 2016

Objectives: This study assessed patients' views of a methadone programme in a Dublin general practice including the degree to which the patients were ‘involved in decisions about their treatment’.

Method: All patients receiving methadone were asked to participate. A face to face questionnaire, with open and closed questions, was administered. Interviews lasted approximately 30 minutes. Quantitative data were analysed using descriptive statistics and qualitative data were analysed using a thematic approach.

Results: Forty one (87%) of the 47 patients attending the general practice methadone service were interviewed. Of the 39 patients who had used heroin on admission, 69% had stopped and 31% reduced heroin use since starting methadone treatment. A total of 71% reported that the doctor either always involved (59%) or sometimes involved (12%) them in decisions about their treatment. Involvement was interpreted as ‘being listened to’ or ‘having a say’ in deciding methadone dose. Surprisingly those who reported that they were not involved in treatment decisions were more likely to have stopped heroin use (10/11). A significant majority of patients (81%) expressed the desire to stop taking methadone.

Conclusion: Most patients receiving methadone in general practice were listened to and had a say in deciding their methadone dose but did not have an opportunity to engage in more structured or contractual forms of involvement in treatment such as written care plans. In line with a patient centred approach, treatment providers should set their sights beyond the safe delivery of methadone, to provide a service which is centred on patient goals, expectations and choice.
Communication between community mental health services and primary care
Authors: Agyapong Vincent IO , Ahmodu Olorunfemi , Guerandel Allys
Published: March 2016

Objectives: This study aims to assess the rate of six monthly communications between specialised psychiatric services and primary care and to determine factors which predict such communication.

Methods: A retrospective review of the clinical records of all patients attending the relevant local psychiatric outpatient clinic was carried out by all members of the multidisciplinary team to identify patient demographic and clinical variables as well as to determine if there has been documentation of communication with primary care in the preceding six months. Letters were sent to the relevant primary care teams regarding progress on their patients in cases where it was identified that no communication had occurred in the preceding six months.

Results: A total of 145 patients' charts were reviewed. Of these, 53.3% of the patients were females and 46.7% were males. The mean age was 47.9 years (SD = 14). Patients' diagnoses included; depression (41%), bipolar affective disorder (6.7%), schizophrenia/schizoaffective disorder (27.6%), anxiety disorders (6.7%), alcohol dependency syndrome (11%) and other disorders (7%). Overall, only 36% of patients' charts had a record of communication with primary care in the last six months. Only one variable, ‘changes made to the patents medication in the last six months’ was significantly associated with the likelihood that there had been communication with primary care with an odds ratio of 15 and a p-value of 0.00.

Conclusion: A six monthly review has a potential to improve the level of communication between specialised psychiatric services and primary care.
Recovery from mental illness: changing the focus of mental health services
Authors: Oshodi Abiola , Rush Gavin
Published: March 2016

The concept of recovery entered the lexicon of the mental health services in the 1980s following the publication of a series of studies and personal narratives which demonstrated that the course of mental illness was not always one of inevitable deterioration and that people diagnosed with severe mental illness could reclaim or recover meaningful lives. For a long time, recovery was not thought possible by many family members, service providers and researchers. However globally, specific policy and clinical strategies are being developed to implement recovery principles although key questions remain. In fact, the possibility of recovery is still debated by some. In this paper, we include information about the recovery model and the medical model; we provide evidence for recovery and document changes in mental health practices and policies incorporating recovery as the guiding principle. We also attempt to address the debate as to whether recovery is an evidence based practice. We propose that evidence based practice should be complementary to value-based and narrative-based practices and we suggest an integrative model that maximises the virtues and minimises the weaknesses of each practices (see Figure 1).
Sexual dysfunction and antidepressants: a review with emphasis on treatment
Authors: Kenny Maeve , Jabbar Faraz
Published: March 2016

Sexual dysfunction (SD) is widely recognised as a potential side-effect of antidepressant therapy. SD has been reported with all classes of antidepressants (MAOIs, TCAs, SSRIs, SNRIs and newer antidepressants) in patients with depression and anxiety disorders. Increased attention has been directed at the SD produced by antidepressants; not only because its initial prevalence was underestimated but also because of the adverse impact that these side-effects can have on treatment compliance. Although SD is an important adverse effect of antidepressant medication, patients tend to be reluctant to report them if not directly questioned. This suggests that consideration of the doctor-patient relationship is needed when deciding on an appropriate treatment plan.
Hypogonadism in an opioid dependent man
Authors: Nkire Nnamdi , Doran Michael , O'Connor John J
Published: March 2016

We describe here the case of a 45-year-old man with a chronic history of heroin abuse who has received methadone maintenance therapy for 12 years. At admission, on this occasion, for stabilisation on methadone, he reported a two-year history of painful gynaecomastia and testicular atrophy. Investigations revealed abnormal sex hormone levels. Liver function tests, thyroid function tests, Brain (pituitary) MRI and viral screens were normal. Following assessment and abnormality in two morning total testosterone level measurements he was diagnosed with hypogonadism secondary to opioid use. Although he had a previous history of alcohol abuse, he was abstinent from alcohol use for five years at time of assessment. He was commenced on parenteral testosterone replacement with therapeutic benefit.

In light of the increased use of opioids, it is important to recognise and manage the endocrine complications of opioid use. The need for an empathic and adequate sexual history, physical examination and investigation is essential in patients who use opioids to ensure that cases of hormonal dysfunction are detected early and managed appropriately.
Clinical evaluation of carbohydrate deficient transferrin as an indicator of alcohol dependence
Authors: Naik Prakash C , Webb Tim , McLean Phillip C
Published: March 2016

Objective:To evaluate the clinical usefulness of carbohydrate deficient transferrin (CDT) as an indicator of alcohol dependence (DSM 111R).Method:Subjects included 18 patients with alcohol dependence and 36 controls (15 recovering alcohol dependents and 21 blood donors). Blood samples from the subjects were analysed for CDT, mean corpuscular volume (MCV) and γ Glutamyltransferase (γGT). These indicators were compared for their sensitivities and specificities to detect excessive alcohol use.Results:Amongst patients with alcohol dependence, CDT was detected in all (100%), γGT was raised in 8 (44%) and MCV was raised in 4 (22%). CDT was detected in five of the 36 controls.Conclusion:CDT was the most sensitive indicator of alcohol dependence. However, CDT showed a much higher false positive rate compared to previous studies. More research is required to elicit at what level of alcohol consumption CDT becomes positive. CDT could prove to be a clinically useful indicator of excessive alcohol use in future.
Carbon monoxide poisoning and neuroleptic malignant syndrome
Authors: Allen Judith M V , Monaghan Clare E
Published: March 2016

We report a case of carbon monoxide poisoning where symptoms of Neuroleptic Malignant Syndrome developed following use of neuroleptic medication. Literature review has failed to reveal a previous report of neuroleptic malignant syndrome following carbon monoxide insult.
Psychosis and recreational use of MDMA (“Ecstasy”)
Authors: Keenan Eamon , Gervin Maurice , Dorman Arthur , O'Connor John J
Published: March 2016

A seventeen year old man attended the National Drug Treatment Centre with a paranoid psychosis following ingestion of Methylene dioxy methamphetamine (MDMA). He had been taking MDMA on a recreational basis over a five month period. Although chronic psychosis after heavy use of MDMA has been reported there are no pervious reports of psychosis following recreational use. This report highlights the psychological dangers of this drug, which has become widely misused in Dublin over the last two years.
Bipolar disorder patients' attitudes to and knowledge of their illness: a retrospective study
Authors: McKeon Patrick , O'Loughlin Fionnuala
Published: March 2016

Objective: To assess the effect of specific psychoeducational sources – support group meetings, lectures and literature – on bipolar disorder patients' knowledge and attitude to their illness. Methods: Eighty bipolar disorder patients attending for a lithium blood test were asked to complete a questionnaire detailing their demographic characteristics, duration of illness, knowledge of manic-depressive illness and their attitude towards their illness and what exposure they had had to relevant support group meetings, lectures and literature on bipolar disorder. Results: The 43 group attenders had a statistically significant higher mean score on the illness and lithium knowledge and the attitude to illness sections of the questionnaire than the 30 patients who did nto attend groups (P<0.001). A multiple regression analysis indicated that, in addition to group attendances, only reading literature contributed significantly to illness knowledge and attitude. Age, sex, duration of illness and socio-economic status did not contribute significantly to these outcome variables. Conclusions: Bipolar disorder patients who attended support group meetings and availed of relevant literature knew more about their illness and lithium therapy and expressed more positive and realistic views about their illness than those who only read literature and attended lectures.
Maternal views of the management of foetal remains following early miscarriage
Authors: Jackman Catherine , McGee Hannah , Turner Michael
Published: March 2016

Objective:Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women.Method:Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements.Results:Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted.Conclusions:Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.
Endocrinology and the psychiatrist
Authors: Breathnach Caoimhghin
Published: March 2016

Objective:Exegetic review of the three areas of common interest to the endocrinologist and the psychiatrist.Method:Literature review through Science Citation Index and references in BMJ, Lancet, Nature, and Science.Findings:Psychiatric symptoms, specific in each condition, may develop in the course of a classical endocrinopathy. Though introduced as a possible diagnostic aid, titration of the hypothalamico-pituitary control of the adrenal and thyroid glands has proved to be a useful research strategy and possible prognostic indicator in affective disorders. Growth in our knowledge of the behaviour effects, distribution, function and pathophysiology of neuropeptides during the last two decades opens a magic casement on their potential value in neuropsychiatric theory and therapy.Conclusion:The psychiatrist ignores endocrinology at his peril, as does the endocrinologist psychiatry, especially in regard to the emerging role of peptides in neuromodulation.
Do cases of neuroleptic malignant syndrome cluster?
Authors: Huckle Phil , Kellam Alexander , Williams Peter , Tanaghow Amgad , Lloyd Alan
Published: March 2016

Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction to neuroleptic medication. Both the incidence and aetiology of the NMS are matters of considerable controversy. We present a clustering of cases of NMS in a distinct geographical area in South Wales. Five cases were reported in an eight month period in 1990 and more recently, a second cluster of three cases occurred in a three week period in November, 1991. We discuss some of the possible explanations for this apparent “epidemic” of cases in South Wales.
A new developmental epidemiology of schizophrenia: the HRB Schizophrenia Research Unit, 1991-92, and contemporary perspectives of the disease
Authors: Waddington John L , Larkin Conall
Published: March 2016

General aspects of research funding in the biomedical sciences are briefly discussed and some specific issues of policy considered, as they relate particularly to the Health Research Board's Unit strategy. The origins, objectives and workings of the Board's Schizophrenia Research Unit are elaborated, in relation to contemporary perspectives of this illness as a neuro-developmental disorder, and the extent of progress made over it's first year of operation is outlined. It is argued that the ‘neurodevelopmental hypothesis’ now has substantial foundations; it provides an important conceptual focus, both for the field in general and for the Health Research Board's Schizophrenia Research Unit in particular.
Childhood hallucinations in the context of parental psychopathology: two case reports
Authors: Cryan Elizabeth M J , Ganter Kathleen
Published: March 2016

Three children who experienced hallucinations in two single-parent families are described. The children's symptoms subsided when the families were treated using a family therapy approach. This report highlights the need for mental health professionals to be aware of the possible response of children to parental psychopathology.
Primary care based psychiatric clinics: observations on a one year cohort of referrals
Authors: Cooper Stephen J , Gilliland Andrew , McGilloway Sinead , Doherty Michael , Cormac Elizabeth
Published: March 2016

A one year cohort of referrals (n=178) to a primary care based psychiatric clinic in a large Health Centre is described. Fears that such a clinic might detract from treatment provided for psychotic patients seemed unfounded. Waiting time for assessment was short and patients were more likely to attend than at hospital based clinics. Admission rates were considerably reduced. Contact between patients and their general practitioner seems to continue at a high level even during psychiatric intervention but half of the “frequent attender” group cease contact. The pattern of attendance on follow-up suggests that many patients may receive unnecessarily long out-patient care.

The evidence to date suggests that such clinics provide a useful service but other aspects of quality of care require evaluation.
Transsexualism in a Klinefelter male: a case report
Authors: Cryan Elizabeth M J , O'Donoghue Frank P
Published: March 2016

We report a Klinefelter male who presents requesting gender reassignment surgery. There may be a predisposition to gender dysphoria in Klinefelter's Syndrome, and in the case we describe, the perception of his symptoms as being of biological origin coupled with the unavailability of gender reassignment surgery in the Republic of Ireland has had a negative therapeutic effect.
Delusional dish syndromes
Authors: Kidd Brian , McGilp Robin , Stark Cameron , McKane Joseph P
Published: March 2016

The content of delusions can reflect recent changes or developments within the environment.

We describe three cases which illustrate, to our knowledge for the first time, the incorporation of Satellite Television Dishes within the experience of psychosis.
The Hillsborough football stadium disaster: a single case study
Authors: Travers Raymond F , Baker Gus A
Published: March 2016

Expectations for service provision following a disaster are understandably high but difficult to meet. This report considers the case of a patient with pre-morbid anxiety traits and asthma who suffered organic brain damage as a consequence of the Hillsborough Football Stadium disaster, whose care was reactive rather than proactive and resulted in his compulsory admission to a psychiatric hospital. Aftercare arrangements need to be anticipated in advance and should involve early psychiatric assessment of at-risk patients. Medical control of case management following disasters needs further clarification.
Medical audit in an elderly depressed cohort
Authors: Donnelly Peter
Published: March 2016

Medical audit was carried out to evaluate drug therapy in a cohort of depressed patients admitted to a functional ward for the elderly. A retrospective case note study was carried out in 61 consecutive admissions with a diagnosis of depression. Seventeen of the 41 patients (41%) with a diagnosis of Manic Depressive Psychosis were not taking antidepressant medication on admission. Of the 11 patients who received Electroconvulsive Therapy seven (64%) did so under Section 3 of the Mental Health Act. Four of the 41 patients (10%) with a diagnosis of Manic Depressive Psychosis were not on prophylactic antidepressants or lithium on discharge. Seventeen of the patients (28%) were taking benzodiazepine hypnotics on admission, and 14 of these were discharged on the same type and dosage. There were no patients on more than one type of antidepressant or antipsychotic at any one time. These findings reflect deficiencies in the general practice and specialist treatment of depressive illness in an elderly cohort. The need for on-going audit in this at risk group is emphasized.
Deliberate self-harm: a comparison of first-time cases and cases with a prior history
Authors: Gupta Kamal , Sivakumar Kandiah , Smeeton Nigel
Published: March 2016

Objective: Eighty one patients admitted following deliberate self-harm were assessed using a semi-structured interview. The aim of the study was to compare clinical and social profiles of the 42 patients who had committed self harm for the first time with those of the 39 who had committed self harm in the past.

Method: The patients were assessed jointly by a psychiatrist and either a community psychiatric nurse or a social worker. A description of past suicidal behaviour, socio demographic information, medical and psychiatric history were recorded. Suicide intent was assessed both from the clinical interview and rated objectively using Pierce's suicide intent scale. Psychiatric diagnoses were made using the ICD 9 classification.

Results: The entire group had experienced difficulties in sustaining relationships. This problem was significantly more widespread in repeaters with increased use of physical violence in their relationship. More patients with a previous history claimed to have death wishes at the time of self harm, and asserted that they would harm themselves again compared with patients without a previous history. Clinical predictions regarding future self harming behaviour were in line with the patient's stated intentions.

Conclusion: The persistent desire to commit self harm and more widespread relational difficulties amongst the patients with a previous history suggests a need for different treatment strategies and outcome measures for the two groups.
Oedipism and ocular self-mutilation
Authors: Hingorani Melanie , Singh Arun , Williams Hugh
Published: March 2016

Self-enucleation is a rare and disturbing form of self-mutilation. A case is reported in which a schizophrenic patient simultaneously attempted the three main forms of major self-mutilation, that is self-enucleation, amputation of the penis and of the right hand. The historical background, underlying psychiatric factors and possible complications are discussed.
Rapid cycling mania post head injury
Authors: Cooney Golm , Lawlor Brian A
Published: March 2016

A case of post traumatic rapid cycling unipolar mania is described in an individual with no apparent genetic predisposition to an affective disorder. A head injury is proposed as being causative. It is suggested that head injury should be included as a cause of rapid cycling affective disorder.
Unfit to plead in Ireland
Authors: Hutchinson Lynn , O'Connor Art
Published: March 2016

In Ireland patients who are found unfit to plead are automatically detained in the Central Mental Hospital (CMH) at the pleasure of the court. The CMH is the only high security psychiatric hospital in the Republic of Ireland. There is no limit on the length of detention and no review system in place. We reviewed the case notes of all the prisoners admitted to the CMH since 1937 who were found unfit to plead. We identified 24 cases which included only one female. The mean age was 33.5 years. Nearly 25% had a criminal record and over 60% had a past psychiatric history. The primary diagnoses were schizophrenia (12), mental handicap (4), personality disorders (3), psychotic episode (2), dementia (2) and manic depression (1). The average length of stay in the CMH was 18 years. We review the situation in the UK and in the USA and we make recommendations about legislation.
Police referral of compulsory admissions — a comparison study
Authors: Doyle Harry , Delaney William
Published: March 2016

Objective: To determine the characteristics of compulsory admissions by the police and to compare them with compulsory admissions by other means. Method: A retrospective review over one year of the case records of 48 consecutive compulsory admissions after referral by the police was compared with 96 other randomly chosen compulsory referrals over the same period. Results: In both groups a majority had a chronic history of mental illness with frequent prior compulsory hospitalisation. Significant differences were found between the two groups with the police group more often younger, single, unemployed, males. They were also significantly more likely to suffer from schizophrenia and to have had their admission precipitated by behaviour of an assaultive nature, or by property offences, and on admission to spend a shorter period in hospital. Conclusions: It is suggested that at-risk case registers and the use of alternative emergency procedures will serve to lessen the need for police intervention with the mentally ill.