bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of referral letters to a department of old age psychiatry
Authors: Campbell Fiona , Parsons Brian , Loane Ruth
Published: March 2016

Objective: There is a paucity of literature on the content of referral letters to psychiatric services and few relating specifically to referrals to a department of old age psychiatry. There has been a significant increase in referrals over the last five years to this service, which may reflect the ageing population and a greater awareness of the service. Our objective was to evaluate the quality and legibility of information received, clarity of reason for referral and details of pre-referral management.

Methodology: The clinical records of the first 100 referrals in 2002 to this department were analysed. The referral letters were examined for the documentation of a number of demographic variables, reason for referral, interventions to date and level of urgency.

Results: The clinical records of nine patients did not have an identifiable referral letter at the time of this analysis. Of the remaining 91 analysed, 59% were referred by their GP, 33% were inpatient liaison referrals and 8% from outpatient departments. In the majority, patients' details were given, however, only 30% included a phone number. Next-of-kin was mentioned in 29%. GP's name was included in 71% of referrals from OPD and 7% of liaison referrals. The level of urgency was stated in 19%. Whether a domiciliary or OPD visit would be more appropriate was stated in 22%. The reason for referral was clear in 75%, with 43% including some aspect of Mental State Examination, 7% had included a MMSE score, 1% mentioned level of suicide risk.

Thirty-one per cent had pre-referral investigations and 45% had pre-referral treatment documented. The letters were clearly legible in 73%.

Conclusion: The information in the referral letter in many cases was insufficient to prioritise and expedite appropriate assessment. It is planned to introduce a proforma referral form, specific to old age psychiatry, which would include the information which is required and which would, hopefully, lead to a more efficient service.
Facilitating journey to recovery
Authors: Khan Hammad , Murray Emmet
Published: March 2016

The Irish ‘Vision for Change’, 2006 mental health policy document proposes a framework for promoting mental health and a recovery approach to inform every level of service provision. Comprehensive assessment by the rehabilitation and recovery multidisciplinary team with active involvement of the service user is crucial in the identification of needs, goals and recovery factors. This paper outlines importance of a comprehensive assessment tool, which helps to guide the service user towards identification and achievement of their goals while encompassing the recovery ethos.
Dr Ada English: patriot and psychiatrist in early 20th century Ireland
Authors: Davoren Mary , Breen Eugene G , Kelly Brendan D
Published: March 2016

Dr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.
Deliberate self-harm in children and adolescents: an 11-year case note study
Authors: McNicholas Fiona , Fagan John , Tobin Brid , Doherty Mairin , Adamson Neil
Published: March 2016

Objective:To retrospectively examine the case-notes of all children and adolescents admitted with deliberate self-harm (DSH) or suicidal ideation during the study period 1993-2003. The study aimed to identify underlying reasons why children and adolescents engage in DSH, and to identify common psychiatric, psychosocial and familial factors which may predispose or contribute to an individual's engagement in such behaviour.

Method:All children presenting to the hospital with DSH or suicidal ideation were identified and data collected from their case notes. A study specific questionnaire was designed to collect demographic details, details on clinical presentation, past attempts, comorbid psychiatry disorders, family history and family circumstances. Information was also recorded on hospital stay and discharge planning.

Results:During the 11-year period, 231 children presented with suicidal ideation or behaviour. The mean age was 12.85 with an age range from 6-17 years, with a female:male ratio of 2.5:1. Overdose was the most common method (81.2%) and paracetamol most commonly the drug of choice. More than half of the group (55.7%) expressed a wish to die. More than half (51.8%) had expressed suicidal ideation in the past, 31% had made a previous attempt, and 11.7% had been previously admitted. Of the children 8% presented with suicidal behaviour more than once over the study period. There was a family history of completed suicide in 6.6%.

Conclusion:Deliberate self-harm in young people is a significant public health problem in Ireland. During the period of this study, rates have continued to increase. There is an urgent need for national bodies such as the National Suicide Review Group to extend their focus to include those under age 18 and for services to be developed that might reduce DSH behaviours. More research is needed in the area of childhood suicidal behaviour.
Antidepressant augmentation and combination in unipolar depression: strong guidance, weak foundations
Authors: Kolshus Erik , Douglas Leonard , Dunne Ross
Published: March 2016

Depression will be the second leading contributor to the global burden of disease by 2020. In Ireland, in 2009, 6061 people were hospitalised with depressive disorders. This represents a significant economic and social burden. There is growing awareness of the difficulty in treating depression with medications alone. The likelihood that a patient will achieve remission with the first antidepressant tried is around 30%, and the rates are similar for the second antidepressant tried. This falls to around 15% after three trials. Many patients are exposed to pharmacotherapy for extended periods of time with little beneficial effect, but often with side-effects. Patients are therefore in great need of clear information with regard to their chance of success. Clinicians are in need of clear guidance on prescribing strategies which have proven efficacy. However, this guidance often discusses treatment strategies based on varying levels of evidence. Guiding bodies may approach the problem from varying perspectives. The UK National Institute for Health and Clinical Excellence (NICE) has a clear government mandate with regard to provision of not only effective but cost-effective treatments. The British Association of Psychopharmacology (BAP) is an independent body of interested researchers and therefore may discuss prescribing options from the point of view of tertiary care institutions, and university centres. The South London and Maudsley NHS Foundation Trust publish the popular Maudsley guidelines. These are perhaps more pragmatic in nature, but include very low levels of evidence, including case series.

The American Psychiatric Association (APA) is an independent member association which also publishes guidelines. These are published in the American Journal of Psychiatry and the latest guidelines were published in October 2010.

All these bodies attempt to weigh their advice according to the level of evidence available and aim to provide clinical guidance in difficult situations. The burden on guiding organisations is to provide some direction and clarity in areas that are often unclear or controversial. Clinical guidelines are one method of providing support and guidance to busy clinicians. However, this clinician-centered approach has limitations. The onus is on the authors of the guidance to provide ever-more treatment options. This may mean that conclusions about the efficacy of medications is overstated or the limitations of the literature not fully explored in explanatory notes.
Whack induced psychosis: A case series
Authors: El-Higaya Emam , Ahmed Mohamed , Hallahan Brian
Published: March 2016

‘Whack’ is a new psychoactive substance available until recently in ‘head shops’. It contains two active constituents, 4-fluorotropacocaine and desoxypipradrol. We present two case reports of subjects who developed acute psychotic states after using Whack. Both individuals displayed similar affective and anxiety symptoms in the presence of significant psychotic symptoms. Both required inpatient treatment but displayed a good treatment response to atypical antipsychotic agents. To our knowledge, this is the first published case series relating to this psychoactive substance.
Exhaustion, depression and hopelessness in cardiac patients: a unidimensional hierarchy of symptoms revealed by Mokken scaling
Authors: Doyle Frank , Kowalczyk Aleksandra , McGee Hannah , Conroy Ronán M
Published: March 2016

Objectives: Depression and vital exhaustion are associated with poor cardiovascular prognosis, but there is substantial overlap between these constructs. Factor analytic studies have been inconclusive, and may not be the optimal analytic strategy to assess dimensionality. We assessed whether exhaustion and depression formed a single, hierarchical dimension using a form of nonparametric item response theory.

Methods: Patients with acute coronary syndrome (n = 430) completed questionnaires assessing depression and vital exhaustion. Mokken scaling was used to assess dimensionality.

Results: Mokken scaling formed a strong unidimensional scale, ordered in a hierarchy reflecting prevalence: fatigue (common), depression (less common) and hopelessness (rare).

Conclusions: Depressive symptoms form a clear hierarchy in cardiac patients, from fatigue to hopelessness. Vital exhaustion may be considered a less severe form of depression. Use of hierarchical scales may allow clinicians to better determine clinical significance and target interventions.
ECT: An investigation of lay attitudes and experiences in an Irish sample
Authors: Besani Chiara , Hevey David , Mangaoang Maeve , Lucey James V
Published: March 2016

Objectives: Electroconvulsive therapy (ECT) is one of the most controversial psychiatric treatments of the modern era. Few studies have used validated scales to examine attitudes and knowledge regarding ECT in lay people. We examined attitudes, knowledge and experience of ECT using standardised questionnaires in Irish lay people, and compared the present results with the findings from a similar study reported over 25 years previously.

Methods: A total of 103 lay people were recruited from a variety of settings and completed a questionnaire. Data were analysed using independent samples t-tests, χ2 tests and Pearson correlations.

Results: Attitudes to ECT among Irish lay people are negative and knowledge of the treatment is poor. A significant correlation (r = 0.32) was found between knowledge and attitudes, with higher levels of knowledge associated with more positive attitudes. People with relatives who experienced ECT had a significantly higher ECT knowledge than the people without such relatives (p < 0.05).

Conclusion: Results confirmed previous findings and revealed novel statistically significant factors that contributed to attitudes towards ECT. Further replications are required to examine the findings' robustness and the relationship between attitudes, knowledge and experience. Such research can help increase the understanding of ECT and remove the stigmatisation associated with ECT. Mental health education programmes should consider the relation between knowledge and attitudes to better inform programme focus and content.
Sociodemographic profile and mental health needs of referrals to an Irish psychiatric service: a transcultural perspective
Authors: Ahmed Mohamed , Dineen Brendan , O'Brien Sinead , Carney Philip A
Published: March 2016

Objectives: This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.

Method: Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.

Results: One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.

Conclusions: There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.
Lithium and prevention of cognitive impairment
Authors: Abidin Zareena , Cooney Colm , Jackson Deirdre , Freyne Aideen
Published: March 2016

Objective:To examine the rate of cognitive decline and occurrence of dementia among patients attending a lithium clinic for those aged 65 years and over.

Method:Retrospective chart review of the cognitive function of 29 patients receiving maintenance lithium treatment attending the Dublin South East Old Age Psychiatry service, over a nine-year time period.

Results:Twenty-nine patients were included in the study (20 female, nine males), with a mean age of 79 years. Two patients had concurrent dementia. Six patients fulfilled ICD10 criteria for mild cognitive disorder and all of these patients also fulfilled revised consensus criteria for mild cognitive impairment amnestic subtype. Sixteen patients were commenced on lithium as an augmentation treatment for recurrent depressive disorder, 12 patients were on treatment for bipolar affective disorder and one patient on treatment for schizoaffective disorder. Patients had been receiving lithium treatment for an average of 109 months with follow-up by the service for a mean duration of 38 months. The initial mean MMSE score of patients at first presentation to the service was 26.9 (SD = 5.6) compared to a mean MMSE score 25.8 (SD = 5.8) (CI of change in MMSE score at 95% level = −2.1 and 0) at follow-up. The mean MMSE of patients with mild cognitive impairment prior at first contact with the service was 26.8 (SD = 3.2) and at follow-up was 26 (SD = 3.2) which was not statistically significantly different (p=0.40) (CI for change in MMSE at 95% level = −3.2 to 1.5). No patient had developed incident dementia during the follow-up period of the study.

Conclusion:The results tentatively suggest that lithium may have a protective effect against cognitive decline and a neuroprotective role in patients with concurrent affective disorder and cognitive impairment. Multi-centre prospective studies of cognitive function in patients attending lithium clinics are needed to examine the neuroprotective properties of lithium.
Two-year study of the use of neuroimaging in a psychiatric inpatients unit
Authors: Alugo Tolulope , Badejo Johnson , Whitty Peter
Published: March 2016

Objectives: Neuroimaging is being used increasingly in the investigation of psychiatric disorders. Previous studies have found abnormalities in about two-thirds of all scans done in psychiatry. The aim of our study was to investigate the use of CT and MRI in the management of inpatients in psychiatry department Adelaide & Meath hospital, Tallaght and to examine the relationship between diagnosis and abnormalities seen on scans.

Method: We did a two-year retrospective study of all inpatient referrals for CT scans/MRI scans. A case note review of bio-demographic data, diagnosis, relevant medical history, substance misuse history, indication for tests and results of scans was done. We found that 66 CTs and MRI scans were done over the study period.

Results: Fourteen (21%) of the scans had abnormal results which were mostly atrophic changes. Of the 14 abnormal scans, seven had abnormal findings on neurological examination. We found a lower number of abnormal scans compared to previous studies.

Conclusions: Radiological abnormalities were not disease specific. We wish to propose guidelines on the indications for using neuroimaging in psychiatric patients.
Epilepsy at a large psychiatric hospital: survey and audit of its management
Authors: Haw Camilla
Published: March 2016

Objectives:Although epilepsy and psychiatric disorder are known to be associated, little is known about the nature of epilepsy in psychiatric inpatients and how well psychiatrists manage psychiatric patients with epilepsy. The aim of this study was to describe the nature of epilepsy in patients at a large specialist independent psychiatric hospital and to audit the management of epilepsy using patients' records.

Method:Cross-sectional survey of inpatients and audit of clinical documents. Audit standards were derived from good clinical practice and UK guidelines.

Results:In total, 83/488 (17%) patients had a life-time history of epileptic seizures and 67 (14%) were receiving anti-epileptic drugs. The prevalence of epilepsy was 37% among brain injury patients, compared with 10-11% in adult male and female forensic patients and in the elderly and 2% in adolescents. Generalised tonic-clonic seizures predominated. Common aetiological factors were: traumatic brain injury, antipsychotics, cerebral hypoxia, cerebrovascular disease and learning disability. In 53/67 (79%) cases the care plan stated the patient had epilepsy but in only 20 (30%) was the seizure type recorded. For 30 (45%) there was no history of how epilepsy had been diagnosed. Of those patients with a history of status epilepticus, 5/15 (33%) had a readily accessible emergency treatment plan. The patient's last seizure was incompletely documented in 29/44 (66%) cases, while for only 7/67 (10%) patients was there documented evidence of a review of epilepsy management within the past year.

Conclusions:Epilepsy was common in this group of psychiatric inpatients. Documentation and management needed improvement and to be in line with national guidelines.
Relapse of postictal psychosis following 14-year symptom-free period
Authors: Uhoegbu Chimdi , Lannon Rosaleen , Cooney Colm , Freyne Aideen , O'Shea Diarmuid
Published: March 2016

Neuropsychiatric sequelae in patients with epilepsy have been vastly studied and documented. These may be affective, cognitive or psychotic. Certain risk factors may predispose some epileptics more to these sequelae. In general, good epileptic control may minimize these outcomes. We present in this report, a case of postictal psychosis (PIP), superimposed on delirium, in a 68-year-old woman, with history of a single previous psychotic illness following a cluster of seizures. This report shows a collaborative management of the neuropsychiatric complications of temporal lobe epilepsy (TLE), by the neurology, geriatric medicine and psychiatry teams.
The prevalence of alcohol dependence syndrome in a rural general hospital in Northern Ireland
Authors: Mangan Brian G , Patterson Diana G
Published: March 2016

Objective:To estimate the prevalence of alcohol dependence syndrome in a rural General Hospital.Method:The entire inpatient population of 107 patients was administered the CAGE questionnaire to detect alcohol dependency. Patients scoring two or more (maximum score 4) were diagnosed alcohol dependent.Results:Sixteen patients were unable to complete the questionnaire due to severity of illness or dementia. Of the 91 patients who completed the CAGE questionnaire, 20 scored one or more, and 12 scored two or more, giving a prevalence of probable alcohol dependency in this population of 13%. There were significantly more male alcohol dependent patients than female, 30% vs 2% (p<0.001). Fifty percent of the patients who scored on the CAGE as alcohol dependent were not recognised by medical staff as being problem drinkers. All of the alcohol dependent patients came from the medical and surgical units including Ear, Nose and Throat surgical unit (ENT).Conclusion:Administration of the CAGE questionnaire to all medical and surgical admissions seems to be one of the most economical way of detecting alcohol dependency and engaging patients in treatment as early as possible.
Clozapine for the treatment of levodopa-induced psychosis and dyskinesia in Parkinson's disease
Authors: Jalenques Isabelle , Coudert André-Julien
Published: March 2016

The treatment of psychosis in patients with Parkinson's disease (PD) is one of the most difficult problems in clinical psychiatry. Clozapine's low propensity to induce extrapyramidal side effects makes it an attractive treatment for psychotic patients with PD. A number of published uncontrolled studies suggest that low-dose clozapine is effective in these patients. However, the dose range, side effect profiles and length of treatment have varied in these reports. In this article, the authors review the literature and report on the effects of clozapine in a patient with Parkinson's disease and psychosis. Clozapine (50mg per day) resulted in a complete resolution of psychosis, improvement of motor function, reduction of “off” time and a major improvement in levodopa-induced dystonic dyskinesias. The only adverse effect was mild sedation during the first two weeks of clozapine treatment. The lack of acute blockade of striatal D2 receptors by clozapine and the failure of chronic clozapine treatment to suppress striatal dopamine release may account for its beneficial effect in Parkinson's disease. Additionally, an ameliorating effect of clozapine on parkinsonism might be due to its action on serotonergic systems leading to release of striatal dopamine.
Involuntary admissions to a district mental health service – implications for a new mental treatment act
Authors: Carey Teresa G , Owens John M
Published: March 2016

Objective: The aim of this study was to examine the working of the 1945 Irish Mental Treatment Act in relation to compulsory admission and detention and to establish issues that will need to be addressed in imminent new legislation. Method: A 3 year retrospective study was carried out on all compulsory admissions to the Cavan/Monaghan Psychiatric Service using case note material. The circumstances surrounding application for compulsory admission in one year of the study period were further investigated by delivery of a schedule to Relative-Applicants. Results: The study revealed rates of compulsory admission equivalent to other Irish regions but much higher than neighbouring jurisdictions. There was no evidence of deliberate abuse of the act. Indications emerged of excessive and inappropriate recourse to certification by some relatives and General Practitioners. Excessive length of detained stay and lack of specific procedures for informing patients of their rights were evident. Conclusions: A new Mental Treatment Act will need to place much greater emphasis on patients' civil rights while facilitating access to treatment.
Adolf Hitler: a re-assessment of his personality status
Authors: Henry Desmond , Geary Dick , Tyrer Peter
Published: March 2016

Objective: The assessment of the personality status of Adolf Hitler using a structured interview schedule, the Personality Assessment Schedule, with two informants, one a psychiatrist with an interest in psychohistory and the other a historian with special knowledge of the Third Reich and Weimar Republic. Method: The Personality Assessment Schedule was given in two forms to the two informants at different times; on each occasion Hitler was assessed as he was in 1937. Results: There was considerable discrepancy between the ratings of the two informants, the historian recording less-personality disturbance in all areas of function, although correlations between the two sets of ratings were relatively high (R1 0.5-0.6), with rater bias accounting for the differences in severity. Both informants regarded Hitler as having a dissocial personality disorder (using the new ICD-10 criteria), but the psychiatrist's rating also scored the diagnosis of paranoid and histrionic personality disorders. Conclusions: Interview schedules which use informants to assess personality disorder can be of value in examining the personality status of historical figures.
Nintendo hallucinations: a new phenomenological entity
Authors: Spence Sean A
Published: March 2016

Increasing exposure to video technology has provoked descriptions of psychopathology related to playing video games. However, there exists no description of hallucinatory phenomena occuring in psychotic illness deriving from such material. The subject of this report is one such patient suffering from a persistent auditory hallucination of computer music and other non-verbal information.
The controlled drinking controversy
Authors: Tobin John , Delaney William , Doyle Harry
Published: March 2016

Objective:of the review was to explore the three major controversies over the controlled drinking debate, and to assess for whom controlled drinking may be a viable form of treatment of alcohol dependence.Method:was to survey the literature of the last twenty years, using the Medline data base, the Index Medicus, and the Excerpta Medica.Findings:were that controversies involving the work of the Sobells and the Rand reports were influenced by the social attitudes of the time, and that D.L. Davies work despite being methodologically unsound, made the consideration of having a controlled drinking goal a viable treatment option. We also found that comparing studies using different definitions of controlled/normal drinking is difficult, but it would appear that the young, married, less severely dependent, and possibly female drinker may benefit from this form of treatment. The return of a patient to controlled drinking is not always dependent on the treatment model they have undergone.Conclusions:are that controlled drinking should be considered as a serious option, and that the recommended safe alcohol intake, will differ between patients, and that flexibility will be required. Also that a source of ongoing collateral information about the patient is essential.
Audit of psychiatric emergencies in the A & E department of an urban general hospital
Authors: Webb Marcus , Webb Douglas , Webb Glenn
Published: March 2016

Objectives: To ascertain the frequency and nature of emergencies referred to psychiatrists at the A & E Department of an urban teaching general hospital. Deliberate self-harm and other forms of violence were to be special foci of the study, as was substance abuse, particularly alcohol abuse. Clinical management strategies used by psychiatric emergency staff were also to be assessed. Method: A retrospective audit was made of all of the reports of emergencies written by psychiatric trainees (who were first on call to the A & E) during a six-month period (January-June, 1991). The reports were analysed according to demographic characteristics, main clinical problem, presence or absence of each special focus problem, and also clinical management strategies. Main outcome measures were recorded as percentages of relevant groupings. Mean and median ages were reported as indicated. Results: The 550 emergency psychiatric reports represented 2.2% of A & E attendances. Fifty-two percent were male and 70% were between 15 and 44 years of age. Forty-eight percent resided outside the psychiatric catchment area of St. James's Hospital. Forty-six percent of all psychiatric emergencies required careful assessment of suicidal potential; twenty percent were admitted to inpatient care, 53% were referred to out-patient or day-patient care, 7% to their general practitioner and just 3% to social services. Conclusions: 1. Emergency assessment at the A & E provides a considerable workload for the psychiatric service of an urban general hospital. 2. Careful assessment of suicidal potential still represents an important part of this emergency work. 3. Only 1 in 5 patients were referred on to in-patient care. Undue pressure should not be placed on psychiatric trainees to manage potentially suicidal patients outside hospital. 4. Few referrals were made by psychiatric trainees to general practitioners or to the social services, suggesting that more formal consultant supervision of trainees in this emergency work is warranted.
Cognitive dysfunction in recently detoxified female alcoholics
Authors: Blennerhassett Richard , Schneider Antonie , Tubridy Patrick , O'Loideáin Domhnall S , Shelley Rory K
Published: March 2016

Objective:To assess the extent of cognitive impairment in a group of female alcoholics and to examine if any relationship was present between the degree of cognitive impairment, and the duration of alcohol dependence, impairment of liver function or associated prescribed medication abuse.Method:The subjects were thirty consecutive women in a residential alcoholism treatment programme who were assessed two weeks after detoxification. The visual reproduction subtest of the Wechsler Memory Scale was used, together with four subtests of the Wechsler Adult Intelligence Scale: vocabulary, similarities, block design and object assembly. We examined the effect on these scales of prolonged alcohol abuse (>5 years), abnormal liver function tests and prescribed medication abuse.Results:The group showed a significant impairment on the subtests, similarities, block design and object assembly when compared with the general population mean for the WAIS-R. Analysis of sub-groups showed little statistically significantly greater impairment on cognitive testing then the remainder of the group.Conclusions:The pattern of cognitive dysfunction for the group indicated subjects had deficits in abstraction, visual spatial and visual motor reasoning similar to previous studies involving male alcoholics. The usefulness of the sub-group comparisons was limited by the small numbers involved and larger studies would help clarify the role of contributory factors in the development of cognitive dysfunction in alcoholic subjects.
Psychotropic drug regimes in compulsive water drinkers
Authors: Cooney John A
Published: March 2016

Objective: To assess the importance of psychotropic medications in Compulsive Water Drinking (CWD) among psychiatric inpatients. Method: The psychotropic medication regimes of 21 CWD inpatients (16 of whom had a diagnosis of schizophrenia) and 21 age and sex matched control inpatients were compared. The CWD group was selected on the basis of urine specific gravity testing amongst the non-geriatric rehabilitation population of a Canadian psychiatric hospital. Regular and prn medications were compared by type and dose. Results: Both groups had generally similar regular medication regimes. No significant differences were found for any of the more commonly prescribed medications. There was a nonsignificant tendency for more CWD subjects to be given prn psychotropics, likely a consequence rather than a cause of the polydipsia. Conclusion: No significant differences were found between the two groups. However, because of the large number of medications used and the relatively small number of subjects, the study has relatively low power. A larger study, combining the CWD inpatients of several hospitals, would be required to definitely rule out a role for psychotropics in the aetiology of CWD.
Left hemisphere & cerebellar damage in Asperger's syndrome
Authors: El-Badri Selim M , Lewis Margaret Anne
Published: March 2016

A case of Asperger's syndrome is presented with evidence of left hemisphere and cerebellar abnormalities.
Major depressive illness with secondary pathological gambling – case report and literature review
Authors: O'Dwyer Anne-Marie , Sheppard Noel P
Published: March 2016

The case of a lady who developed a major depressive illness with secondary pathological gambling is described. The gambling was manifest by uncontrolled purchasing of lottery tickets. The inter-relationship between affective disorder and pathological gambling and the effect, if any, of lotteries on pathological gambling is discussed.
Flashbacks and schizophrenia
Authors: Obaydi Hazim
Published: March 2016

Three cases of schizophrenia (DSM-III-R) (l), whilst responding to treatment, exhibit a group of symptoms which had the essential features of “flashbacks”, as described in relation to psychedelic drugs, though there was no evidence of psychedelic drug misuse. Symptoms were characterised by memory flashes of the original psychotic experience, followed immediately by very brief re-experiencing of earlier symptoms, including visual perceptual changes in clear consciousness and full insight. Symptoms were less clear, less severe, but more distressing, than the original episodes. Symptoms were triggered by stress/anxiety, and relieved by an anxiolytic. The association of flashbacks with schizophrenia is discussed.
A study of the legal involvement of new patient attenders at a Dublin alcohol treatment unit
Authors: Doyle Harry , Tobin John , Delaney William
Published: March 2016

Objective:To determine the influence of the legal system on new attenders at an alcohol treatment unit.Method:One hundred and forty seven new patient referrals to an alcohol unit were examined prospectively over a four month period. Data were obtained by standard psychiatric interview, drinking history inventory, Severity of Alcohol Dependence Questionnaire and a detailed questionnaire of present and past legal involvement. Subjects were then followed up and the numbers remaining in treatment after the first visit and after one month ascertained.Results:Both legally referred and non-legally referred groups had significant past legal involvement while those attending under legal pressure were found to be as severely addicted as other referral types and to have no greater drop out rate from treatment.Conclusion:It is suggested that legally pressured attenders should be accepted into treatment as readily as other referral types and that greater liaison between the criminal justice system and alcohol treatment units is required.
Procedures for involuntary admission to public and private psychiatric facilities
Authors: Farren Conor , McLoughlin Declan , Clare Anthony
Published: March 2016

Objective: The aims of this study were to assess the procedures for involuntary admission to both public and private psychiatric hospitals as determined by the Mental Treatment Act, 1945 which is one of the oldest pieces of mental health legislation in the EC. Method: Over a prospective five month period all involuntary admissions to both a public and a private hospital in Dublin were studied. Social-demographic data and clinical features of 54 involuntary admissions were recorded and analysed. Results: 11.2% of public admissions were involuntary as were 3.4% of admissions to the private hospital. The most common diagnoses were schizophrenia and mania. 74.1% of the patients had been previously admitted. 81.5% of the patients were detained in hospital for less than three months although they were committed for a potential six months. There was no formal method of decertification. Conclusions: There appears to be little need nowadays for differentiating between legislation for public and private patients. The duration of the initial reception order should be reduced from six months to a period of forty-eight hours for initial assessment and treatment. If necessary this could be extended to three months. Formal methods for decertification are required. Mental health legislation in Ireland needs to be modernised.
Dexamethasone suppression test in mentally handicapped subjects
Authors: Keane Verena , Soni Saroj
Published: March 2016

Objective:This study investigated the frequency of abnormal Dexamethasone Suppression Test (DST) in a randomly selected group of mentally handicapped subjects.Method:Forty three subjects living in the community were selected and assessed on a variety of clinical rating scales including Hamilton Rating Scale for Depression (HDS) and Wessex Case Register Form (WCRF). DST was conducted on all the patients and the findings correlated with demographic and clinical variables. Groups defined by DST status were also compared using t-test. In subjects who showed an abnormal response, clinical assessments and DST was repeated after 3 months.Results:Only 7 of 43 subjects showed an abnormal response which did not correlate with either the severity of affective symptoms or the presence or absence of behavioural difficulties. Six of the 7 DST positive subjects were either severely or profoundly impaired on DSM-III criteria indicating that the underlying brain pathology may be pathogenetically important. This was supported by the observation that abnormal DST response was enduring at follow up.Conclusions:The findings suggest that DST may be of little value as a diagnostic tool in the mentally handicapped.
An outcome study of a brief anxiety management programme: Anxiety Control Training
Authors: Snaith Philip , Owens David , Kennedy Eileen
Published: March 2016

Objective: Anxiety management techniques may all be expected to produce immediate therapeutic effect; more information is required on long term outcome after contact with the therapist ceases. The study is an independently monitored enquiry into the outcome of a brief technique, Anxiety Control Training. Following eight ten-minute instructional sessions with the therapist, assessments were made by a person who had not been involved with the treatment. Medication was withheld throughout the whole period of the study and ‘booster’ sessions were not given in order that an estimate may be made of the degree of subsequent improvement which may be attributed to the patient's own resources and continued practice of the technique. Method: The study was conducted on a sample of patients referred to an anxiety management service suffering from a phobic disorder. Assessments of the severity of the phobia and of generalized anxiety were made at commencement of treatment, at the end of the eight sessions and thereafter at three month and nine month intervals. Follow up assessment of all patients included in the sample was achieved. Results: At inception into the treatment phase seven of the 22 patients suffered from a moderate to severe degree of generalized anxiety in addition to phobia. As expected a significant (p<0.001) degree of improvement in phobic severity occurred during the period of therapy. Following termination of therapy further significant (p<0.01) improvement occurred up to the final assessment. The number of patients suffering from generalized anxiety was too small to allow confident conclusion but the results suggest improvement in generalized as well as phobic anxiety. Conclusions: The instructional sessions of the ACT procedure provide skill in mastery over anxiety. The subject may continue to use this skill without further aid from the therapist; with regular practice of the technique progressive improvement is likely to occur.
Neuroleptic malignant syndrome in two sisters
Authors: Hosty Gary
Published: March 2016

The occurrence of neuroleptic malignant syndrome in two sisters is described. The possibility of there being any genetic predisposition to develop the syndrome is raised.
Command hallucinations, schizophrenia and sexual assaults
Authors: Jones Gareth , Huckle Phil , Tanaghow Amgad
Published: March 2016

Command hallucinations have been implicated in some cases of physical assault by patients with schizophrenia. This paper is, to our knowledge, the first in the literature to describe sexual assault and this form of psychopathology.

A brief series of four young male patients with schizophrenia who attempted and, in one case, succeeded in sexually assaulting young women as a direct response to command type or imperative auditory hallucinations is described.

All four patients had limited or no sexual experience prior to the incidents described and their illness has attacked them at their “psychological Achilles heel”.

All four had lengthy in-patient admissions and proved quite resistant to conventional treatments.

We would suggest that command hallucinations need to be taken very seriously: some patients do as their voices command.
The phenomena of “bingeing”
Authors: Ballard Clive G , Mohan Ramilgan N C , McGibben Laurence , Kurian Matthew , Silveira W Raza
Published: March 2016

Different authors have used markedly different definitions of bingeing. Probably the most widely used of the current definitions is the DSM III R definition which states that a large amount of food must be consumed over a short period of time. Three case histories and a case vignette are used to illustrate the different clinical syndromes which may include bingeing, when bingeing is defined in this way. The authors argue that cognitive constructs are a more precise way of defining bingeing within the context of eating disorders.
Bipolar affective disorder and thrombocytopenia
Authors: Evans Timothy , Marshall Philip D
Published: March 2016

This report describes the case of a 62 year old man with late onset bipolar affective disorder whose mood swings were associated with episodes of thrombocytopenia. The inter-relationships between affective symptoms, the immune system and the hypothalamic pituitary axis are discussed.
School refusal, parental control and wider systems: lessons from the management of two cases
Authors: Coulter Stephen
Published: March 2016

Two cases of school refusal are presented. From the experience of these two cases, and support from the literature, early assessment of parental control in cases of school refusal is advocated. When parental control, even with professional therapeutic support, is not sufficient to effect an early return to school, intervention in the wider systems which are organised around the problem is recommended.
Children's sexual behaviour and knowledge: a community study
Authors: Fitzpatrick Carol , Deehan Ann , Jennings Siobhan
Published: March 2016

Objective: To provide contemporary information on sexual behaviour and knowledge among normal Irish children, as perceived by their parents.

Method: The study was carried out in an Eastern Health Board urban Community Care Area. The parents of a random sample of all three year olds, and all seven and 12 year olds attending mainstream primary schools within the community care area formed the study population. A semi structured interview was used, covering demographic data, general play, sexual knowledge, sexual behaviour and family behaviour.

Results: A total of 233 parents participated, giving a 67% response rate. Approximately 40% of children in each age group were reported by their parents as showing interest in their own genitalia, this being significantly more common in boys. Approximately one half of three year olds were reported by parents as engaging in play with their own genitalia, this activity becoming increasingly uncommon in the older age groups. Sexual play with other children was reported by 12.5% of parents, and was significantly more likely among the three year olds and amongst boys. Explicit sexual behaviour involving older children, such as oral genital contact or attempted intercourse, were not reported for any child. Interest in genitalia of family members was very common in three year olds, while touching genitalia of family members was unusual. Approximately one third of parents had had some discussion with their older girls about pubertal bodily changes, but male adolescent bodily changes were rarely discussed. Mothers were the usual source of information on sexual matters to children of both sexes.

Conclusions: Sexual interest and exploration are common is young children, while explicit sexual behaviours which come to adult attention are unusual. Little discussion takes place between parents and older children, particularly boys, about specific aspects of reproduction including pubertal bodily changes.
Alcoholism diagnosis and Celtic names
Authors: Carney Michael WP , Sheffield Brian F
Published: March 2016

Objective: To investigate assertions that Celts have higher rates of alcoholism and mental illness than non-Celts.

Method: The records of 3,000 admissions to Northwick Park Hospital Psychiatric Unit, Harrow (a North West London suburban middle class borough research hospital with a strictly defined catchment area – the London Borough of Harrow: population 200,000), from June 1987 for three years under the clinical care of four consultant psychiatrists, were examined.

Results: There were 683 with non-Celtic names and 175 with Celtic names (16.7%) (data on 10 patients incomplete). 306 (35%) of non-Celts and 88 (50%) of Celts were aged under 40 years. Alcohol dependence (ICD 303) was significantly commoner (p<0.001) among the Celts (35.3%) than among the non-Celts (12.9%). There were highly significant excesses (p<0.001) of native-born Celts with ICD 303 (54%) compared with non-Celts 12.9% or with Celts born outside Celtdom (23%). Patients with Norman names tended to follow the Celts in these respects. There were no differences with respect to the prevalence of psychosis or other ICD categories among Celts and non-Celts.

Conclusion: Doctors should be aware of the high prevalence of alcoholic dependence among people with Celtic names, whether these were born in Celtic countries or not, entertain a high index of diagnostic suspicion and take preventative measures accordingly. However, we found no excess of other categories of psychiatric disorder among Celts as compared with non-Celts. Patients with Norman-derived names seemed to follow the Celts in these respects.
The use of the hospital anxiety and depression scale in an outpatient alcohol treatment clinic
Authors: Vassilas Christopher A , Nicol Andrew , Short Clare
Published: March 2016

Objectives: To validate the hospital anxiety and depression scale (HAD) in an outpatient alcohol treatment centre.

Methods: Forty three patients referred to an alcohol outpatient treatment centre completed the HAD which was validated against the external criteria of the Montgomery-Asberg Depression Rating Scale and the Clinical Anxiety Scale.

Results: The HAD performed well operating at a cut-off of 7/8 for the depression scale and for the anxiety scale of the HAD the optimal cut-off value was 10/11.

Conclusion: The HAD is acceptable to patients and its use in alcohol treatment clinics is recommended as a screening instrument for anxiety and depression which can easily be administered by non-psychiatrists.
Anxiety disorder in dementia
Authors: Ballard Clive G , Mohan Ramalingam NC , Patel Abdul , Graham Candida
Published: March 2016

Objective: To estimate the prevalence of anxiety disorders and to explore several potential aetiological factors. Method: Ninety two consecutive patients assessed at a day hospital for patients with probable dementia were interviewed using the CAMDEX schedule. Fifty eight patients gave a sufficiently reliable interview and had a first degree relative in close contact as an informant and were hence included in the study group. The prevalence of RDC generalised anxiety disorder in this group was determined. Type of dementia, severity of dementia and insight were explored as possible aetiological factors. Results: The prevalence of RDC generalised anxiety disorder was 31%. Fifty percent of these patients suffered from anxiety symptoms in the context of RDC major depression. Anxiety disorders were most common in those with mild dementia and in those who retained insight, both showing a trend towards a significant association with anxiety. Conclusions: Anxiety disorders are very common in dementia sufferers particularly in those with mild dementia. Further research is needed in this area, particularly with respect to treatment.