bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychogenic non-epileptic seizures in an Irish tertiary referral centre for epilepsy
Authors: O'Brien Finian M , Delanty Norman , Dineen Catherine , Murphy Kieran C
Published: March 2016

Objectives: To examine the prevalence, psychiatric co-morbidity and management of psychogenic non-epileptic seizures (PNES) in patients admitted to a tertiary referral Epilepsy Monitoring Unit (EMU).

Methods: Medical records of patients admitted to the EMU between 2003 and 2005 were examined and data from neurological, neuropsychiatric and neuropsychological assessments were analysed.

Results: Over a three year period 224 patients were referred to the EMU and 44 (20%) were diagnosed with psychogenic non-epileptic seizures (PNES). A total of 13 people (6%) were diagnosed with both PNES and epilepsy. Of those diagnosed with PNES 34 (75%) were referred to psychology services for cognitive behavioural therapy (CBT) and 26 (58%) were followed-up by psychiatry services.

Conclusions: The prevalence rates for PNES and co-existing PNES and epilepsy are consistent with previous reports. Rates of psychiatric co-morbidity were less than would be expected in this clinical population. Clear evidence-based guidelines to manage people with PNES are required.
Opiate substitution prescribing in Belfast – two year follow up study
Authors: Collins Ruth , Ewing Derek , Boggs Bob , Taggart Noel , Drillingcourt Aileen , Kelly Martin , Patterson Diana
Published: March 2016

Objectives:The objectives of the study were to identify the characteristics of the patients who were commenced in a newly developed opiate substitute prescribing (OSP) programme, to determine their rate of retention and to ascertain the patients' opinions of the service. We also wished to determine rates of blood borne viruses in this population.

Methods:Data were collected from three sources: the Shaftesbury Square Hospital Substitute Prescribing Database, patient charts and an anonymous user views questionnaire. We also conducted viral screening. Inclusion criteria were opiate dependence according to ICD-101for at least one year, in individuals who were 18 years of age or older. The sample comprised the first 80 patients who attended the service, who were followed up over two years.

Results:A total of 44% of our original cohort remained engaged with the service two years after commencement. Of the remainder, 18% engaged with OSP elsewhere and 13% completed a successful detoxification from all opiate drug use. Factors which were associated with continuation in the programme were prescription of methadone (as compared with buprenorphine), female sex and higher doses of OSP. Patients reported high levels of satisfaction with the service. Of those who were tested for blood borne viruses, more than half were positive for hepatitis C infection.

Conclusions:The response to the development of the opiate substitution programme demonstrated that there was a need in the community which had not been met in the past. Service users who attended the programme reported high levels of satisfaction.
Dual diagnosis in a Dublin tertiary addiction centre - A cross-sectional study
Authors: Iro Chinedu , O'Connor John
Published: March 2016

Objectives: To address the relative dearth of information relating to the prevalence of psychiatric co-morbidity among attenders of community addiction facilities.

Methods: We carried out a cross-sectional study of clients attending a Dublin-based tertiary addiction centre to assess the rates of psychiatric co-morbidity, determine the demographic and clinical variables and evaluate the level of contact with allied medical care especially primary care and community psychiatric services. Information was sourced from available patient records.

Results: Forty-three per cent of the clients (n = 59), attending the service were found to have a chart diagnosis of psychiatric disorder. Only 15% of these were in contact with community psychiatric services.

Conclusions: This high rate of psychiatric co-morbidity has implications in terms of funding, training and service delivery.
The borderlines of bipolar affective disorder
Authors: Byrne Sharyn , Jeffers Anne
Published: March 2016

This paper provides an overview of the major studies of bipolar affective disorder (BAD) and borderline personality disorder (BPD), and assesses whether the disorders might be better understood as variants of the same basic disorder. There is a shortage of research that delineates the features of both disorders within their representative samples. As a consequence the symptomatic overlap of the disorders, detected by categorical assessment instruments, is often misconstrued as an indication of the disorders' high rates of comorbidity (up to 81%).

In paying particular attention to features of both disorders, eg. affective instability and impulsivity, the paper provides evidence that BPD attenuates bipolar disorder along the spectrum of affective disorders, from non-classical bipolar presentation through to severe BAD with borderline features. The paper cites clinical, research and pharmacologic support of the contention that BPD, rather than representing a distinct disorder, is merely an attenuation of Axis I disorders, most especially bipolar affective disorder. Borderline personality is evident across the bipolar spectrum and exacerbates symptomatology and leads to poorer recovery prognosis.
Deliberate self-harm (DSH) out of hour's presentations
Authors: McNicholas Fiona , O'Sullivan Michael , Lennon Ruth , Doherty Mairin , Adamson Neil
Published: March 2016

Objective: To establish time of presentation to paediatric accident and emergency (A&E) services of children with deliberate self-harm (DSH).

Method: All children presenting to an acute paediatric hospital with DSH or suicidal ideation between 1993-2003 were identified and time of presentation collected from their case notes.

Results: Of the 172 children where the actual time of presentation was recorded, the majority of children – 137 (80%) presented to the hospital outside of the ‘normal working hours’ of 9am-5pm, Monday – Friday. These children represent an at-risk group, and were more likely to have consumed alcohol, to have made a suicide attempt, and to have a family history of psychiatric illness than children presenting with “normal working hours”.

Conclusion: DSH in young people is a significant public health problem in Ireland and is a major risk factor for completed suicide. Access to an out of hours on-call Child and Adolescent Psychiatry (CAP) services is essential if these children are to have a mental health assessment, as recommended by the Royal College of Psychiatry and National Institute of Clinical Excellence. These services need to be urgently developed.
Tardive dyskinesia on low dose risperidone
Authors: Alugo Tolulope , Kelly Finian , O'Grady-Walsh Ann , Whitty Peter
Published: March 2016

Tardive dyskinesia is a neurological disorder characterised by involuntary and purposeless movements affecting any part of the body. These movements typically occur in the oro-facial area and the patient is usually unaware of them. There are inconsistent findings in the literature on the risk factors for developing tardive dyskinesia. Nevertheless, previous reports indicate that tardive dyskinesia is more common in female patients, patients with a history of alcohol and substance misuse, affective disorders, and intellectual disability. The dose, class and duration of antipsychotic nmedication may also be independent risk factors. We report on the case of a patient who developed tardive dyskinesia on a low dose of the second generation antipsychotic risperidone.
Social and psychological correlates of happiness in 17 European countries
Authors: Doherty Anne M , Kelly Brendan D
Published: March 2016

Objectives:

Happiness has been associated with a number of individual and societal factors, but much of the individual-to-individual variation in happiness remains unexplained. The purpose of this paper is to examine a broad range of social and psychological correlates of self-rated happiness in Europe.

Methods:

We used data from the European Social Survey to determine levels of happiness in individuals (n = 30,816) from 17 European countries and to identify associations between happiness and age, gender, family relationships, satisfaction with income, employment status, community trust, satisfaction with health, satisfaction with democracy, religious belief and country of residence.

Results:

Self-rated happiness varies significantly between European countries, with individuals in Denmark reporting the highest levels of happiness and individuals in Bulgaria reporting the lowest levels. On multi-variable analysis, happiness is positively correlated with younger age, satisfaction with household income, being employed, high community trust and religious belief. Overall, these factors account for 22.5% of the individual-to-individual variation in happiness in Europe.

Conclusions:

For the individual, this study highlights possible associations between happiness and the individual's attitudes towards various aspects of their personal, household and societal circumstances. For social policy-makers, this study suggests the potential usefulness of civic measures to increase community trust and social capital. Further studies of the inter-relationships between individual and community-level variables would assist in further explaining the variance in happiness between individuals and countries.
Suicide in Ireland: a cross-national view
Authors: Lester David
Published: March 2016

Recent epidemiological trends in Irish suicide rates were examined and found to be consistent with worldwide trends. However, the time-series Irish suicide rate was not consistent with predictions made from Durkheim's classic theory of suicide. Finally, current theories of the etiology of suicide were used to derive a linear regression equation to predict the Irish suicide rate which turned out to be quite inaccurate.

The task addressed in this article is a review of the epidemiology of suicide in Ireland and, in doing so, the suicide rate in Ireland will be compared with the suicide rates of other nations of the world.Table 1reports the suicide rate in Ireland from 1901 to 1949,Table 2for the period 1950–2001, overall and for men and women (and parallel data for Northern Ireland are shown inTable 3). These data were compiled from Lester and Yang and from World Health Organisation publications and online (www.who.int). It should be noted that suicide was decriminalised in Ireland in 1993.
Lycanthropy, mythology and medicine
Authors: Moselhy Hamdy F , Macmillan J Fiona
Published: March 2016

A case of schizophrenia with the belief and behaviour of being a dog has been presented with a review of literature of lycanthropy.
Voluntary false confessions in a Munchausen patient: a new variant of the syndrome?
Authors: Abed Riadh T
Published: March 2016

A case of Munchausen syndrome associated with habitual voluntary false confessions is described. It is suggested that voluntary false confessions may be an overlooked feature ofMunchausen syndrome. Furthermore, it is suggested that this case raises the possibility that a yet unidentified variant of Munchausen syndrome may exist which substitutes prison for hospital.
Changes in alcohol history taking by psychiatric junior doctors: an audit
Authors: Taylor Simon J
Published: March 2016

Objective: In recent years a number of articles have highlighted deficiencies in drinking histories taken by junior doctors. This study examines whether standards have improved as a result. It also examines for the first time: 1. the quality of drinking histories taken from patients following parasuicide; and 2. the quality of illicit drug usage histories.

Method: An audit of case notes was undertaken of 114 patients admitted to a district hospital's acute psychiatric wards or assessed following overdose. Two periods were considered; one preceding many of the articles, and the second four years later.

Results: There was an overall improvement from 58% of histories in 1988 having no mention of alcohol usage to 25% in 1992. (X2MH=10.57, p<0.01). There was, however, insufficient improvement of quantitative histories to reach statistical significance. Histories taken as part of an overdose assessment were not significantly different from those taken for inpatient admission. In 1992, 27% of patients had any illicit drug usage history recorded which represented a statistically significant improvement (X2MH=5.91, p<0.02) compared with four years earlier.

Conclusions: Although improvements have been noted, alcohol and drug histories remain inadequate.
Early life experience in elderly women with a history of depression: a pilot study using the Brief Parenting Interview
Authors: Mullan Eleanor , Orrell Martin
Published: March 2016

Objective: The relationship between early adverse experience and psychological illness has been studied in younger adults, but not in the elderly. This study investigated early adverse experience in elderly women with a history of severe depression by using a semi-structured interview.

Method: Women admitted with a history of severe depression were identified and interviewed using the Brief Parenting Interview (BPI)(n=14).

Results: The majority of elderly women (71%) with a history of severe depression had suffered significant childhood trauma. Eight (57%) women reported parental loss, six (49%) reported tension or discord in the family home and one woman reported severe child sexual abuse. The majority of the women (87%) did not find the questionnaire distressing and all found it acceptable.

Conclusions: Considering the high prevalence of childhood trauma in this group and the problems treating severe depressive illness in the elderly, this area deserves further study. The BPI is well tolerated in elderly women with a history of depression.
Medication discrepancies at the GP/psychiatric hospital interface
Authors: Hickey John , Donnelly Peter
Published: March 2016

Objective: To quantify the perceived discrepancies between the medication that GPs believed their patients were taking and that which was recorded on admission to acute psychiatric wards.

Methods: A prospective survey of 107 consecutive admissions to a Swansea psychiatric hospital was carried out.

Results: In 62% of patients studied, there was at least one discrepancy each and in 33%, the discrepancies were considered potentially clinically significant.

Conclusions: The study showed a significant number of potentially serious discrepancies in medication at the GP-Hospital interface and highlighted the need for improved communication between GPs and their psychiatric colleagues. The possible reasons for the discrepancies and the implications for communication between primary and secondary care for psychiatric patients are explored.
Observations of the observed: a study of inpatients' perceptions of being observed
Authors: Moorhead SR , Langenbach M , Kennedy J , Hodgson CM , Ruiz P , Junaid O
Published: March 2016

Objective: Examination of the process of therapeutic observation, as performed by nursing staff on acute assessment wards, from the perspective of adult inpatients.

Method: One week after admission, patients were asked to complete a questionnaire, enquiring whether they had noticed their observation, and the extent to which they found it intrusive. Diagnoses were categorised by ICD–9, from the case-notes. Chi-square was used to analyse the results.

Results: Fifty six per cent of patients perceived changes in the intensity of their observation. Psychotic patients were significantly more likely than the rest (p = 0.016) to feel that they were observed too closely, despite not being uncomfortable with this. There was a trend for patients in the traditional psychiatric hospital to feel more discomfort than those on a psychiatric ward in the district general hospital (p = 0.12).

Conclusion: Respect for privacy and dignity may notentirely be attainable for the most vulnerable group of psychotic patients. Opportunities may exist to improve matters with the closure of asylums and attention to ward layout and design.
Punch drunk syndrome
Authors: Upadhyaya Ajaya K , Kilshaw Lesley , Dyal Rajinder S
Published: March 2016

A case of traumatic encephalopathy from persistent and long-standing self-inflicted punches to the head is described in a patient with obsessive compulsive disorder. This rare complication is best seen as a mild form of ‘punch drunk syndrome’ in the light of the clinical, neuropsychological and radiological findings.
Bipolar affective disorder and autoimmune disease
Authors: Bhandari Sadgun
Published: March 2016

In Bipolar affective disorder, the importance of genetic factors is well established through family, twin and adoption studies. However the exact mode of inheritance is not yet known. Genetic studies using DNA linkage have been attempted to identify susceptibility genes. Linkage studies of chromosome 11 and X chromosome have proved to be inconclusive. Recent studies have focused on chromosome 18 and 21, although confirmatory findings are awaited. As such, determining which part of the genome needs to be studied remains a problem. One way of overcoming this is to look for ‘candidate’ genes, ie. genes for which a priori evidence exists that a susceptibility gene may be located nearby.

Such strategies have been used for example, trying to identify genes of interest by looking at association between chromosomal aberrations and bipolar affective disorder, and the study of co-segregation of certain diseases with affective disorder. More studies are needed to provide regions of interest. I would like to report three cases of bipolar affective disorder with a rare autoimmune disorder, cryptogenic fibrosing alveolitis.
Litigation and the toxicity of psychotropic drugs
Authors: Leonard Brian E
Published: March 2016

All drugs have side effects and given the increase in litigation for medical negligence that has occurred in Ireland in recent years, it would not be surprising to find that clinicians prescribing psychotropic drugs would also become the target for legal procedures if they fail to warn the patient about the possible side effects and toxicity of the drugs they are prescribing. The two extremes of the problem may be illustrated by the litigation carried out against some pharmaceutical firms and prescribers of benzodiazepines and the lack of such proceedings resulting from deaths of depressed patients who take an overdose of a prescribed antidepressant.
Complications of verapamil in psychiatry
Authors: Kaufman Kenneth R
Published: March 2016

Effectiveness of verapamil as a psychotropic and verapamil toxicity when used as a psychotropic are presented in this case study with literature review.
Self-injurious behaviour in persons with a mental handicap: an epidemiological study in an Irish population
Authors: Hillery John Hillery , Mulcahy Michael
Published: March 2016

Objective: The repeated, self-inflicted, non-accidental injury known as Self Injurious Behaviour (SIB) is a cause of severe stress to carers and a challenge to multi-disciplinary teams working with people with a mental handicap. A need for Irish data on this problem was answered by collecting a representative cohort and following its members up to record the prevalence of SIB.

Method: The group studied included all people with an IQ of less than 50 (that is those in the moderate, profound and severe range of intellectual ability) whose place of origin was within the geographical borders of a single community care area. Following a preliminary tracing process, each person was followed up for one calendar month using a specifically prepared format to record daily occurrence of SIB.

Results: The group resulting from the tracing process consisted of 429 people (= 0.4% of the total population), 62 (=14 %) of this group exhibited SIB, during the time of the study. Of the demographic variables studied SIB was found to be related to IQ. Of those who self-injured those who showed multiple topographies and those who showed the greatest frequency of SIB were more likely to be found in the population who lived in a residential facility.

Conclusions: SIB is related to IQ but in a non-linear way suggesting that factors other than IQ militate against more severely handicapped people displaying this behaviour. SIB is not caused by living in a residential centre however our results suggest that living in a residential facility is the result of displaying SIB. This study suggests that implications for future treatment approaches and service provision for those exhibiting SIB in Ireland can be made with reference to research from other countries.
Use of clozapine in a mental handicap hospital — report of the first 17 patients
Authors: Boachie Ahmed , McGinnity Maria GA
Published: March 2016

Objectives: To examine the process and outcome of use of clozapine in patients with mental handicap, with particular reference to selection of patients, response to treatment, adverse effects and withdrawal from treatment.

Methods: The case notes and medication charts of all patients commenced on clozapine between January 1991 and December 1994 were examined.

Results: Seventeen patients had been commenced on clozapine, the majority in the mild and moderate range of handicap. Fifteen had ICD-9 diagnosis of schizophrenia and all were refractory to conventional neuroleptics. Improvement was marked in 47% and substantial in 76%, with a mean daily dose of 453.8(sd = 238.5)mg and a range of 200mg-900mg. Reduction of aggressive behaviour was an important indicator of improvement. Five patients were withdrawn but only one related to side effects. Four patients had a past history of epilepsy and six others either developed seizures or EEG changes on treatment.

Conclusion: Clozapine use has been associated with considerable benefit in patients with mild and moderate handicap wh o have schizophrenia. In this population aggression responded well but a high prevalence of drug-induced epilepsy was evident.
New long-stay patients — two years later
Authors: Gannon Miriam , Meagher David , Watters Liam
Published: March 2016

Objectives: The aims of this study were to review the outcome of those long-stay patients two years after identification and to compare those discharged with those remaining in hospital in order to identify factors which might contribute to their continuing stay.

Methods: All the new long-stay patients who were more than one year and less than six years on 1st March 1992 were included in the study. Their current placement. Legal status and demographic and clinical details were recorded. Findings: Sixtynine percent of the original cohort remained in hospital, 9% had died, and 22 % had been discharged, mainly to highly staffed accommodation. Approximately half of those remaining in hospital were considered suitable for community placement. Those remaining in hospital were older, had longer durations of illness and were more likely to be dangerous than those discharged.

Conclusions: Despite continuing developments in community services a considerable number of new long-stay patients still remain in hospital and the proportion of those compulsorily detained remains unchanged.
The use of naltrexone, an opiate antagonist, in the treatment of opiate addiction
Authors: Farren Conor K
Published: March 2016

Objective: The objective of this article is to review the use of the opiate antagonist naltrexone as an alternative to opiate agonist maintenance in the treatment of opiate addiction.

Method: An extensive literature search, via Medline, Biosis, Psycinfo and other databases was carried out.

Results: Naltrexone has been used in the treatment of opiate addicts in a variety of settings. A number of methods of induction onto naltrexone of recently abstinent addicts have been used in different settings. Naltrexone has had a wide range of outcome success with different populations and associated treatment regimes.

Conclusions: The benefits of naltrexone can be compared with alternatives such as methadone maintenance and therapeutic communities. Naltrexone can be made more effective in the general population of opiate addicts with the use of adjunctive therapies.
Detection of personality disorders by a community mental health team: a study of diagnostic accuracy
Authors: Hassiotis Angela , Tyrer Peter , Cicchetti Domenic
Published: March 2016

Objective: It is now widely recognised that personality disorders play a significant role in psychiatric practice. This study was set up to examine the diagnostic accuracy of the assessment of personality disorder in normal practice by a multidisciplinary community mental health team when compared with a formal assessment using a structured interview.

Method: Forty-four patients originally assessed by team members of the Early Intervention Service (EIS), were re-examined using the Personality Assessment Schedule (PAS ICD-10 and original version) at a mean period of 16.3 months after first assessment. Specifically we tested the extent to which three personality disorder (PD) clusters (flamboyant, odd/eccentric, anxious/fearful) could be differentiated from either no PD at all or from the remaining PD clusters.

Results: As expected, both flamboyant and odd/eccentric PD clusters were much more easily differentiated from no PD at all (overall accuracy of 87 % and 85 % respectively) than from other PD clusters (corresponding accuracy of 65 % and 50%) . In distinct contrast, the anxious/fearful cluster was much less accurately differentiated from no PD (accuracy of only 52%) than from other PD clusters (accuracy of 85%).

Conclusion: The diagnosis of personality disorders in routine clinical practice is fraught with difficulties, especially when mental status symptoms closely resemble personality traits. The present results suggest that greater knowledge, training and experience can facilitate diagnostic accuracy.
Community and hospital residential care: a comparative evaluation
Authors: Carson Jerome , Cullen Deborah , Holloway Frank , Towey Aisling , Jumbo Angela , Smellie Norma , Glynn Tony
Published: March 2016

Objective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.

Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.

Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.

Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.
Diogenes' syndrome — a load of old rubbish?
Authors: Drummond Lynne M , Turner Joanne , Reid Steven
Published: March 2016

Objective: It has been suggested that presentation with self-neglect, domestic squalor and hoarding, represents a distinct syndrome, widely known as Diogenes' syndrome. The validity of this syndrome is controversial and we suggest that in previous series of such patients other psychiatric diagnoses, particularly obsessive compulsive disorder (OCD), may have been missed.

Method: A series of 50 patients admitted for treatment of OCD were examined, looking for presentation with self-neglect, domestic squalor and hoarding. Response to treatment was also measured by comparing pre and post-treatment scores on the Beck Depression Inventory and Activity Checklist.

Results: Of the sample 8% presented with all three features. This sub-group of patient had a poorer outcome than other patients with OCD.

Conclusion: Presentation with self-neglect, domestic squalor and hoarding is not uncommon in patients with severe OCD and this supports the suggestion that patients previously described as having Diogenes' syndrome may have had undiagnosed OCD.
General practitioners' opinion of a new psychiatry of old age service
Authors: Kelleher Margaret
Published: March 2016

Objective: To evaluate the reaction of local general practitioners to a new psychiatry of old age service 10 months following its inception.

Method: An anonymous questionnaire was sent to all GPs in the catchment area of the Service. Questions asked the opinion of GPs on structure and process of the Service, and also asked for suggestions as to how the Service could patients did not have any reservations about being seen by a psychiatrist, but 72% of rural GPs felt the location of the service base (in the city) was a problem.

Conclusion: The results of the study suggest that GPs are reasonably satisfied with the initial service offered by the new specialty. Future service developments must address issues highlighted such as access to the service for patients living outside the city, improving the inpatient facilities for patients with a functional mental illness, and improving communication with GPs.
Diogenes' syndrome: review and case history
Authors: O'Shea Brian , Falvey Jane
Published: March 2016

Our objective in writing this paper was to present a case of Diogenes' syndrome and to examine the evolution of thinking about the phenomenon. To do this we looked at original case material and then carried out a literature review, the results of this showed the syndrome has been reported most often in the elderly and in higher socio-economic groups. It represents a non-specific final common pathway for many interacting variables.

In our conclusion we found that a detailed multidisciplinary assessment is indicated in all cases. Further work is required to estimate the role of personality disorder and organic frontal lobe dysfunction in the aetiology of this syndrome. A multiaxial approach to diagnosis should be employed. Intervention should be based on objective findings and risk-assessment, rather than on ideological grounds. Irish law does not allow a large variety of options to the helping professions.
Using the Achenbach Child Behaviour Checklist in the differential diagnosis of disruptive behaviour disorders
Authors: Kelly Thomas P , McArdle Paul
Published: March 2016

Objective: The report considers the utility of the Achenbach Child Behaviour Checklist in the differential diagnosis of the disruptive behaviour disorders.

Method: Subscale scores on the parent completed Achenbach Child Behaviour Checklist were compared for three of 15 boys, the first diagnosed with attention deficit hyperactivity disorder, the second diagnosed with oppositional defiant disorder and a third non-clinical control.

Result: The attention subscale of the Achenbach Child Behaviour Checklist was found to have a high level of sensitivity to children diagnosed with attention deficit hyperactivity disorder, but relatively poor specificity. The delinquent subscale was found to have limited sensitivity for oppositional defiant/conduct disorder group, but high levels of specificity. The aggressive subscale were found to have relatively high sensitivity for the oppositional defiant/conduct disorder group and relatively high specificity.

Conclusion: The Achenbach Child Behaviour Checklist is useful in distinguishing between children with disruptive behaviour disorders and a non-clinical sample. The aggressive subscale appears to have potential clinical utility in the differential diagnosis of the disruptive behaviour disorders.
Folie a famille — the need for family perspectives in psychiatry
Authors: McCartney Mark , Leheup Rachel
Published: March 2016

A case of folie a famille is described. The presenting symptom bearer was a child thus necessitating psychiatric contact with his family. This prevented the folie a famille from remaining covert as may have occurred had an adult presented in a similar manner. The possibility is raised that folie a plusieurs has a higher incidence than previously believed. Criticism is made of the tendency of adult psychiatry and its diagnostic systems to focus purely upon the individual. The investigation, formulation and management of the case using the family is outlined.
Isotretinoin therapy and depression – evidence for an association
Authors: Byrne Alan , Costello Morgan , Greene Elaine , Zibin Terry
Published: March 2016

Objectives: The object of this paper is to evaluate the evidence suggesting an association between the use of the anti-acne agent isotretinoin and the subsequent development of depression.

Method: Three case histories of individuals who had received treatment with isotretinoin and subsequently developed depression are reviewed.

Results: All three individuals were noted to have a depressive illness which was notable by the prominence of symptoms of irritability, agitation and aggression.

Conclusions: The indications from the three cases described suggest that there appears to be an association between depression and the recent use of isotretinoin. This may relate to the ability of isotretinoin to simulate hypovitaminosis A, with aggression, irritability and depression as a direct result of this effect. Young males may be particularly prone to developing this response.
Childhood sexual abuse histories in women with drug and alcohol misuse disorders
Authors: Horgan Ann , Cassidy CE , Corrigan Adrian
Published: March 2016

Objectives:To audit the incidence of a history of childhood sexual abuse (CSA) in women with diagnoses of drug and alcohol misuse disorders.

Method:A definition of CSA encompassing the US National Centre on Child Abuse and Neglect's definition of child sexual abuse was used. In the six month period of audit details of CSA were recorded from clinical data for all consecutive female new patients (n = 49) of the substance misuse service in St. Luke's Hospital, Armagh.

Results:Of the 49 new patients, information on childhood sexual abuse was available for 44 subjects. Sixteen (36.36%) of 44 had a positive history of CSA.

In 13 (81.25%) abuse occurred before the age of 16 years. Sexual intercourse was described by 50% and sexual contact by 50%. Only one patient had reported CSA to the police and only one patient had received counselling. There was a difference noted in the addiction profile of those with a history of CSA, 44% of this group had either alcohol dependence syndrome/harmful use of alcohol compared with 66% of the non-CSA group. The perpetrators were all male.

Conclusions:Our audit confirmed other work which showed a high incidence of childhood sexual abuse histories in addicted women. This is one of the areas which may not be properly addressed by conventional addiction treatment programmes, which are male centred and male dominated. It adds to the growing body of evidence that suggests adaptations must be made as increasing numbers of women present for addiction problems.
An audit of violent incidents in a drug treatment centre
Authors: Fahy Sabina , Browne Roy , Sloan Darina , Keating Shay , O'Connor John
Published: March 2016

Objectives: The aim of this study was to examine the prevalence of, and factors associated with violence in a drug treatment centre.

Method: This study is a retrospective audit of all incident forms completed at an urban drug treatment centre between December 1991 and July 1996 with reference to case notes for additional clinical information on individuals involved in violent incidents.

Participants included all patients attending the centre in the aforementioned time period who were involved in violent incidents. Information was obtained about the prevalence and severity of violent incidents and patient details including main drug of abuse, route of use, reason for attendance, comorbid axis 1 diagnosis, history of previous incidents and HIV status at the time of the incident.

Results: One per cent of all patients were involved in violent incidents. Less than one quarter of incidents involved serious injury or assault. Most perpetrators were male intravenous heroin users on a methadone maintenance programme. Nurses and doctors were most frequently the victims of incidents. Ten per cent of patients had a history of previous incidents and almost half the perpetrators were HIV positive. A comorbid axis 1 diagnosis was found in 9% of perpetrators (n = 6), mainly alcohol dependence syndrome.
Outcome of treatment for Irish alcoholic women
Authors: Corrigan Eileen M , Butler Shane , Camasso Michael J
Published: March 2016

Objective: To assess the outcome of treatment, a cross section of women from seven inpatient centres treating alcoholics were interviewed twice: as they entered treatment (n=114) and one year later (n=74) when they returned to the community.

Method: The patients were interviewed as they began treatment and 65% were traced for interviews one year later. Measures of self esteem, emotional health and drinking patterns are presented over time.

Results: Approximately one half of the women were abstinent when interviewed again and improved emotional health was related to abstinence. Of those who continued to drink many reduced their intake. A logistic regression analysis was applied to the data to explain the results. Among the major findings was the ability of therapists to predict subsequent drinking with a high degree of accuracy.

Conclusions: All of the services have abstinence as their goal. This could be challenged since at follow up only half of the women are abstinent. Controlled drinking may well be a valid objective if abstinence fails or could well be a valid objective for some patients.
Training in psychodynamic psychotherapy: the psychiatric trainee's perspective
Authors: Trigwell Peter J , Curran Stephen , Milton John , Rowe Celli
Published: March 2016

Various problems can occur when embarking upon training in psychodynamic psychotherapy for the first time. If the difficulties experienced by trainees are not given serious attention by supervisors, trainees may give up at an early stage. This paper looks at the subjective difficulties experienced by three junior trainees in psychiatry in adjusting to such training, and includes comments in reply from one of the organisers of the course which the trainees attended. It is essential for supervisors to address trainees concerns openly, in order to avoid a further decline in the use of this important part of the “therapeutic armamentarium”.
Non-compliance and related phenomena
Authors: O'Shea Brian
Published: March 2016

Objective:Review of literature on non-compliance with medication in psychiatric patients.

Method:Computer and manual search of English language literature on non-compliance with drugs, psychiatric disorder, and phenomena which may be related, such as readmission and discharge against medical advice.

Results:The literature is discussed and a tentative checklist of risk factors for non-compliance is offered, as is advice on ways in which the problem may be minimised. It is noted that there is an emphasis on major mental disorders in the published literature.

Conclusion:There is no stereotypical defaulter. A high index of suspicion is essential. As far as possible, the patient should be educated to share in the responsibility for treatment, and concerned relatives and others can often play a pivotal role. More research is required on compliance problems in the minor psychiatric disorders. Close liaison with the general practitioner is vital.
Two cases of transvestophilia arising following behavioural psychotherapy treatment of obsessive compulsive disorder
Authors: Rani S , Drummond Lynne
Published: March 2016

Early psychodynamic formulations of obsessive compulsive disorder (OCD)suggest that its aetiology lies in repressed sexual impulses. Despite this, sexual aberration has rarely been reported in conjunction with OCD or arising following treatment. This paper describes two case histories of patients with severe, chronic OCD whose sexually deviant behaviour increased following successful behavioural psychotherapy. Classical Freudian, behavioural cognitive and neuropsychological models for this finding are discussed.
Suicide as a complication of schizophrenia
Authors: Kelleher Michael J , Hynes Fiona , Kelleher Michael JA , Keeley Helen
Published: March 2016

The social, personal, occupational and domestic deficits of schizophrenia are well known. Perhaps it has not been emphasised sufficiently that people suffering from schizophrenia also have an increased mortality. It is important to recognise that suicide is the commonest form of death among both male and female schizophrenics and occurs in 10%-15% of cases.
Dyads and triads of abuse, bereavement and separation: a survey in children attending a child and family centre
Authors: Sheerin Declan
Published: March 2016

Objectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome.

Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made.

Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement.

Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.
A study of sex offending in elderly people referred to a specialised psychiatry of old age service
Authors: McAleer Angela , Wrigley Margo
Published: March 2016

Objectives: The aims of the study were to examine: i) whether sex offending in elderly people is a serious problem, ii) whether mental disorder or alcohol abuse occur in association with such behaviour, iii) how such behaviour is managed by the psychiatric service and iv) the outcome of such management.

Method: Referrals of people with sexually offensive behaviour to the North Dublin Psychiatry of Old Age Service from its inception in 1989 to date (1997) were examined. Information collected included: i) mode and reason for referral, ii) demographic, social and medical information, iii) psychiatric diagnosis, iv) management and v) outcome.

Results: Thirteen cases were identified in the eight year period. The sexually offensive behaviours included indecent assault, masturbation in public and lewd remarks. Diagnoses included vascular dementia, frontal lobe dysfunction, Alzheimer's disease, chronic schizophrenia, depression with alcohol abuse and ‘no psychiatric diagnosis’. Two patients had positive syphilis serology detected on dementia screening. Alcohol abuse featured in almost half of the cases. Regarding treatment, five were treated with oral cyproterone acetate and one with benperidol, and all of these had a good response. Three were treated with neuroleptics and also settled. Specific treatment was not indicated in three cases and forensic services were involved in a further three cases.

Conclusions: It is noted that most subjects had an underlying psychiatric diagnosis particularly organic brain damage. Management alleviated the problem in all cases with psychiatric disorder. Cyproterone acetate is clearly useful in management. This review highlights the importance of thorough assessment, diagnosis and management of sexually offensive behaviour in old age.
Audit of the first year of a psychiatric clinic at a Dublin Maternity Hospital
Authors: Gannon Miriam , Barry Siobhan , Turner Michael
Published: March 2016

Objectives: The aims of the audit were to monitor the activities of the liaison clinic over a 12 month period, to establish the number of attenders and non-attenders and to evaluate whether the service was meeting the needs of patients with perinatal disorders.

Method: The Coombe Women's Hospital is one of three maternity hospitals in Dublin and had 6,452 deliveries and 5,273 inpatient gynaecological procedures performed in 1994. The charts of all the patients who were given an appointment for the psychiatric clinic between January 1 and December 31, 1994 were reviewed.

Results: Fifty-six patients attended the clinic over the 12 month period, 38(68%) of whom were new referrals to the service. Twenty-two patients were antenatal, 20 were postnatal and 14 patients were attending the gynaecology department. Seventeen patients (30%) who were referred to the clinic failed to attend for their first appointment. Forty-one (73%) patients had sufficient symptomatology to make an ICD-10 diagnosis. Medication was prescribed for 58% of those who attended. Four patients were referred to their catchment area service for inpatient care: six patients were referred to their catchment area service for further outpatient care as they had psychiatric illnesses which predated their pregnancies.

Conclusions: The number of patients referred to the liaison service with postnatal depression is remarkably less than that anticipated and there is a high rate of defaulting among first attenders. Various recommendations are made to improve the effectiveness of the service.