bluuebunny/crossref_metadata_2025 huggingface dataset:
The biological basis of schizotypal personality disorder
Authors: Kirrane Richelle M , Siever Larry J
Published: March 2016

Schizotypal personality disorder is the DSM equivalent of the ICD category schizotypal disorder. It may be seen as part of the schizophrenia spectrum of disorders. Patients with schizotypal personality disorder (SPD) share many features with schizophrenic patients. These include symptoms of social isolation and cognitive impairment. They also share imaging and biochemical evidence of brain dysfunction, and genetic similarities. SPD patients, however, for some reason do not become chronically psychotic. The study of schizotypal patients is of great importance in attempting to clarify the genetic and biological basis of the schizophrenia spectrum. It is also important in helping to delineate the differences between schizophrenic and schizotypal patients, and to distinguish those factors that protect the schizotypal patient from becoming floridly psychotic. In this article we present recent findings regarding the biological basis of schizotypal personality disorder. We illustrate the contribution of these findings to our understanding of risk and protective factors in the schizophrenia spectrum.
Spiritual well-being in psychiatric patients
Authors: Mountain Deborah Ann , Muir Walter J
Published: March 2016

Objectives: Some patients with mental illness have said that religion (whether institutional or private) provides them with resources to cope with their illness. The aim of the study was to examine the spiritual well-being and religious practices, beliefs and psychological morbidity of psychiatric patients (n = 41) compared to control groups of patients with chronic medical conditions (n = 40) and community controls attending their GP (n = 39).

Method: The study was a cross sectional survey. The study group were identified in psychiatric rehabilitation and day unit settings, the medical controls from a physical rehabilitation hospital and rheumatology outpatient department and the community controls from a GPs surgery. General Health Questionnaire-28 (GHQ-28), the Spiritual Well-Being Scale (consisting of religious and existential well-being subscales) and an open-ended Religious Survey Questionnaire were personally administered to the groups and information supplemented by casenote data.

Results: Although there were no differences between the groups on the measure of overall Spiritual Weil-Being or on the subscale of Religious Well-Being, the psychiatric group scored lower on the Existential Well-Being subscale (p < 0.001) and had higher scores on the GHQ-28 (p < 0.001). The psychiatric group had increased frequency of private religious behaviour (p < 0.05) (praying and reading the Bible) which were thought to be coping strategies. Existential Well-Being of the whole sample was positively correlated to religious beliefs (feeling close to God (F = 6,337, p < 0.001); believing everything is according to God's plan (F = 2,709, p < 0.05) and having a mission in life (F = 3,563, p < 0.05)) and to religious practice (attending church) (F = 3,489, p < 0.05). Regression analysis of the whole sample showed that 49.5% of the variance in Existential Well-Being could be predicted by the severe depression subscale of the GHQ, but an additional 9.6% of the variance in Existential Well-Being could be predicted by religious beliefs.

Conclusions: The psychiatric group expressed lower life satisfaction and purpose, and were more likely to be single and unemployed. Religious belief does impact on life satisfaction and could be considered as an adjunct in the management of some psychiatric patients.
Rape and sexual assault of the elderly – an exploratory study of 10 cases referred to the Irish Forensic Psychiatry Service
Authors: Collins Philip G , Connor Art O'
Published: March 2016

Objectives: This small exploratory study aims to investigate the characteristics of those convicted of rape or serious sexual assault against an elderly person (aged 65 years or over) who were referred to the Irish Forensic Psychiatry Service for assessment.

Method: A retrospective examination of the case histories of such individuals both at the Central Mental Hospital, Dundrum, Dublin and at Arbour Hill Prison, Dublin between 1989 and 1995.

Results: Ten such cases were found. The most frequent diagnoses were those of schizophrenia and alcohol dependence syndrome. A dual diagnosis of both schizophrenia and alcohol dependence was common. A high percentage of the schizophrenia cases had been previously charged with sexual offences and most were non-compliant with prescribed psychotropic medication at the time of the offence.

Conclusions: A very small number of people with mental illness may be at increased risk of committing a sexual offence against an elderly person. Further study of such offenders is merited.
A rose by any other name: psychiatric outpatients' views on dress and address
Authors: Swift Geraldine , Zachariah Mazly , Casey Patricia R
Published: March 2016

Objectives: The manner in which psychiatrists dress and how they address their patients and in turn are addressed, may impact upon the therapeutic relationship. We undertook a survey to assess patients' preferences regarding doctors' dress and forms of address.

Method: Patients attending four psychiatric clinics were asked to complete a questionnaire asking them to rate photographs of doctors dressed in varying levels of formality, presented in random order.

Results: One hundred and forty-five patients agreed to take part. Patients had a strong preference for their consultants to wear suits but were more ambivalent about NCHDs' attire. When asked to rate the photographs in terms of competence and ease in forming a trusting relationship, suits scored the highest ratings. When asked to rate for friendliness, smart attire scored slightly higher than suits. Of the patients 50% said that they wished to be called by their first name and 50% said that they did not have a preference. Very few patients preferred to be addressed by title but 95% said that they tended to call their doctor by title. Of the respondents 70% preferred to be called patients rather than clients or service users.

Conclusions: The patients in this survey preferred their doctors to dress formally and were comfortable with an asymmetrical form of address.
Medically unexplained symptoms, illness perception and childhood experience in neurology outpatients
Authors: Targosz Sarah A , Kapur Navneet , Creed Francis
Published: March 2016

Objectives: Up to one third of patients presenting to neurology outpatients clinics have medically unexplained symptoms, but the aetiology of such symptoms is not well understood. In the current study we sought to investigate the role of anxiety, depression, cognitive factors and early experience in the development of medically unexplained symptoms.

Method: Fifty-seven new patients presenting to a neurology outpatients clinic were studied. Demographic details were recorded and a Hospital Anxiety and Depression Scale, an Illness Perception Questionnaire, and a Childhood Development Questionnaire were administered. An assessment was made by trained medical investigators as to whether the patients symptoms were medically unexplained or accounted for by organic pathology.

Results: We found that 17 out of 56 patients (30%) had medically unexplained symptoms. Such patients complained of a greater number of symptoms, were more anxious, were more likely to have a past history of depression, and were more likely to attribute their illness to stress than patients with a presumed organic basis for their disease. They were also more likely to have been in foster care as children. High levels of depression and anxiety were strongly associated with the number of physical symptoms and the perceived negative consequences of the illness.

Conclusions: The recognition and treatment of anxiety and depressive disorders may contribute to the management of patients with medically unexplained symptoms. Open discussion of beliefs regarding aetiology are also likely to be of benefit regardless of the presence or absence of organic pathology.
Junior doctors' experience and knowledge of procedures in compulsory psychiatric admissions in Ireland
Authors: Swift Geraldine , Nasir M , Sheehan John D , Casey Patricia R
Published: March 2016

Objectives: Prompted by the current debate in Ireland regarding involuntary detention, we undertook a survey of psychiatric trainees to examine their level of knowledge of the legislation governing such admissions.

Method: Eighty psychiatric trainees working in centres affiliated to a particular training scheme were invited to complete a purpose-designed instrument.

Results: Response rate was 52/80. Trainees were well informed concerning the procedures necessary to initiate detention. Their knowledge of the legal indications for involuntary detention and restrictions on its duration was patchy.

Conclusions: We suggest that training in the area of mental health legislation needs to be increased and to focus on satisfying legal requirements in real-life scenarios.
Post traumatic stress disorder and the adrenal gland
Authors: Tobin John P
Published: March 2016

Low serum and urinary Cortisol has been a consistent finding in post traumatic stress disorder (PTSD). Glucocorticoid receptor numbers are increased. PTSD patients have a significantly lower adrenocorticotropic hormone (ACTH) in response to corticotrophin releasing hormone (CRH) when compared to a control group of normal volunteers. The dexamethasone suppression test exhibits an exaggerated suppression response of Cortisol to dexamethasone, when the dose utilised is lower than that utilised to test patients with depression. Increased urine levels of noradrenaline and dopamine has been noted in patients with PTSD. This is believed to be related to the hyperarousal state of PTSD.
The place and purpose of research training for specialist registrars: a view from the Collegiate Trainees' Committee (CTC) of the Royal College of Psychiatrists
Authors: Ramchandani Pau , Corby Catherine , Guest Louise , Cole-King Alys
Published: March 2016

Research is currently recognised as an integral part of higher training in psychiatry, but can become a poorly structured training experience. The Collegiate Trainees' Committee (CTC) suggests that clear objectives should be set for the use of a trainee's research time, allowing far greater flexibility over the methods by which those training objectives are met. The process of setting and meeting these objectives requires a fundamental review with the possibility of teaching and supervision being increasingly solicited from other professional groups. Without adequate supervision and support many trainees will continue to struggle unnecessarily with research, and lack confidence in using research findings (for their patients benefit) throughout their consultant careers.
What it says in the papers: an audit
Authors: O'Connor Alison , Casey Patricia
Published: March 2016

Objectives: There have been concerns in the international literature that the manner in which psychiatry and psychiatric patients is portrayed in the print media is negative and sensational. If correct this has serious implications for the stigma and prejudice that our patients will suffer. This study was designed to evaluate the content and tone of articles relating to psychiatry. It was compared with a broadly similar study published in 1995 and will form the base from which to measure changes in psychiatric coverage over time.

Method: All the daily broadsheets, one daily tabloid and three Sunday broadsheets were examined for a six month period in 1999 and all articles, letters or headlines incorporating psychiatry-related material were examined. Using specific definitions, articles and headlines were examined for tone and content as well as for the contribution of mental health professionals.

Results: Overall 0.65 articles per newspaper per day were found. News items and feature predominated, with forensic issues receiving the greatest attention. The tone of the articles was either neutral or positive and the improvement in the tone of articles in the tabloids was particularly noticeable when compared with an earlier study. This is very different from the findings of international studies. However, the headlines were more sensational in tone than the contents of the articles themselves. Increasingly the opinion of health professionals was sought but contributions from psychiatrists remained low, writing just two articles and constituting 15% of health professionals whose opinions were sought. Nine per cent of items constituted misuse of terms.

Conclusions: The Irish print media are not hostile to psychiatry and there has been an improvement in tone and type of article in the past five years. Greater involvement of psychiatrists in the media and particularly more direct engagement with editors is required if there is to be a shift from coverage of forensic matters in favour of informative articles as well as improvement in the headline tone.
Childhood ‘risk characteristics’ and the schizophrenia spectrum prodrome
Authors: Morris Mark , Macpherson Robert
Published: March 2016

This review identifies similarities between behavioural indicators of children with future schizophrenia-spectrum disorders and prodromal symptoms in the first episode of schizophrenia. An alternative concept of prodrome is described with implications for early recognition, monitoring and intervention of individuals at risk of future schizophrenia spectrum disorders.
Screening for dementia in primary care - a viable proposition?
Authors: Freyne Aideen
Published: March 2016

Health policy documents recommend screening for cognitive impairment, although in practice this is not implemented. This article looks at the issues which require consideration in implementing a screening programme. These include factors pertinent to the disease under consideration, resources, both personnel and time, lack of experience of cognitive screening at a primary care level, use of screening instruments and uncertainty about management of positive cases. Only by identifying the practical difficulties involved in screening, can steps can be taken to overcome them and to implement screening programmes which are acceptable to the population under consideration and their primary care physicians.
Mass hysteria among high school girls following tetanus toxoid immunisation
Authors: Gupta Rajiv , Vohra Adarsh K , Madaan Vishal , Gaur Devinder R
Published: March 2016

Objectives: This report describes an epidemic outbreak of mass hysteria in secondary school girls in a North Indian village following tetanus toxoid injection. It also attempts to identify the aetiological roles of the immunisation programme and the adverse media reports.

Method: The socio-demographic, clinical, and school environment variables of the 58 symptomatic students were evaluated. Interviews with health staff, parents and school teachers were conducted.

Results: Fifty-eight out of 200 immunised students reported giddiness, headache, vomiting and restlessness. This initiated an exaggerated socio-political response. The majority of the students responded to counselling and reassurance.

Conclusions: This outbreak fulfils the criteria of epidemic or communicable hysteria with mass presentations of unusual behaviour and spread of somatic symptoms without any organic basis. The episode exposed flaws in the immunisation programme and suggests the need to formulate clear guidelines for vaccination, including pre-vaccination counselling.
Screening for excessive drinkers in a Hampshire general practice
Authors: James Alistair , Edwards Guy
Published: March 2016

Objectives:To identify excessive drinking in a Hampshire general practice and evaluate the usefulness of the screening tools employed. Although excessive alcohol consumption is common, only one in 10 heavy drinkers is known to their general practitioner. Early identification of such patients increases the likelihood that successful intervention will decrease their alcohol intake. Screening helps recognise excessive drinkers.

Method:Three hundred and one patients consulting their general practitioner for any reason were interviewed using a questionnaire comprising a drinking history, CAGE, and brief MAST (Michigan Alcohol Screening Test). The medical records of patients identified as drinking excessively were reviewed.

Results:Forty-eight (15.9%) patients were identified as drinking to excess. Only nine of them were known to the general practitioner. The most useful tests were the drinking history and CAGE, detecting 21 and 20 of the excessive drinkers respectively. No single test used in isolation performed adequately, but the combination of a drinking history, including enquiry about binge drinking, and the CAGE was the most productive.

Conclusion:Screening for excessive drinking by taking a simple drinking history and using the CAGE is cheap and easy to administer. Only about one in five of the patients identified in this study had information concerning excessive alcohol intake in their GP records.
Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?
Authors: O'Neill Conor , Sinclair Hamish , Kelly Alan , Kennedy Harry
Published: March 2016

Objective:General psychiatric bed numbers in Ireland have reduced markedly in recent decades. In other jurisdictions such reductions have been accompanied by increases in the prevalence rates of severe mental illness among prisoners. We examined variations in per capita provision of local psychiatric beds and community residential places in Ireland for associations with forensic psychiatric service utilisation.

Method:All admissions via the courts and prisons to the national forensic psychiatry service during the years 1997-1999 were assigned to the appropriate health board. Forensic admission and bed utilisation rates were compared with measures of general psychiatric service provision.

Results:There were 476 admissions via the criminal justice system during the study period (0.74% of all psychiatric admissions in Ireland). A disproportionate number came from the most urbanised area. There were fivefold differences in overall bed and hostel place allocation between Irish health boards. Combined general psychiatric beds were inversely correlated with forensic bed utilisation (Spearman r = -0.75, p = 0.013). These differences showed a strong inverse correlation with forensic service utilisation.

Conclusions:General psychiatric services are relatively under-resourced in areas of greatest predicted need in Ireland. This is associated with increased use of forensic psychiatric services and may reflect accumulation of the mentally ill in Irish prisons.
Clinical use of structural magnetic resonance imaging in the diagnosis of dementia in adults with Down's syndrome
Authors: Strydom Andre , Hassiotis Angela , Walker Zuzana
Published: March 2016

Objectives:Magnetic Resonance Imaging (MRI) has been used to assist the diagnosis of Alzheimer's Disease (AD) in adults with Down's syndrome (DS). However, the interpretation of the scans is difficult and clinical usefulness is uncertain. We aimed to summarise the current knowledge of MRI studies in adults with Down's syndrome with and without dementia and to discuss its implications for clinical practice.

Method:We identified MRI studies in DS by a computerised literature search with Medline, Embase, and Psychlit from 1986 to 2001. We examined the references of identified articles and hand searched relevant journals. Structural MRI studies were selected as this type of imaging is most frequently used in clinical practice.

Results:We included eight volumetric studies in adults with DS. Four of these included adults with DS and dementia. Overall, the size of brain structures such as cerebellum, hippocampus and cortex of adults with DS without dementia was significantly smaller than in normal controls. The basal ganglia were similar in size, and ventricles were enlarged. Furthermore, the size of brain structures in adults with DS and dementia was significantly different than in DS without dementia. In particular, ventricular and hippocampal volumes were affected.

Conclusions:The change in brain structure associated with dementia can be detected on MRI of adults with DS. However, these may be difficult to interpret given the extent to which brain appearance in DS differs from that in the general population. Implications for clinical practice and future research directions are discussed.
Mental health legislation in child and adolescent psychiatry in England and Wales
Authors: McNamara David
Published: March 2016

As colleagues in Ireland and England and Wales are bracing themselves for revisions of their respective mental health legislations, I would like to share some of the joys and tribulations of working within the legal framework of mental health of young people in England and Wales as it stands. (This is the first major reform of UK Mental Health legislation since the 1983 Mental Health Act, which was based on a full review of mental health legislation from the 1950s.)

On first approach, the complexities of this framework can be daunting. However the underlying principles are similar to Ireland's. Ideally, health professionals, parents and children are working together in a co-operative therapeutic alliance. In reality, factors such as time, communication, resources, differences in professional judgements regarding thresholds for concern and action, interagency and interprofessional rivalries impact greatly on our day-to-day practice.
Adult ADHD: a controversial diagnosis?
Authors: Kirley Aiveen , Fitzgerald Michael
Published: March 2016

Attention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity and impulsivity with onset in children before the age of seven years. ADHD is the most common disorder presenting to child guidance clinics and has been shown to be a well-validated diagnosis. Current estimates of prevalence range from 1%5%. The concept of adult ADHD as a clinical entity is an emerging but controversial area in psychiatry. While childhood ADHD is accepted as a reliable and valid diagnosis, the validity of adult ADHD as a disorder is unclear. This paper reviews the likely presenting features of adult ADHD and common comorbid disorders. Guidelines for assessment and management are discussed and the evidence for validity of the diagnosis is critically examined.
A variant of nymphomania in association with obsessive-compulsive disorder
Authors: Mulligan Aisling , Webb Marcus , Gill Michael
Published: March 2016

A case is described of female compulsive sexual behaviour in association with obsessive-compulsive disorder (OCD). This patient had non-paraphitic compulsive heterosexual multiple partner behaviour, which is a symptom complex previously termed nymphomania. There were also nonsexual obsessions, compulsions and avoidance behaviours diagnostic of obsessive-compulsive disorder. The case is presented for its clinical interest, because ‘nymphomania’ is rare, and because the patient presented with symptoms subtly different to others in the literature. The patient consented to her case being reported in the medical literature.
Dealing with violent and aggressive patients: at what cost to nurses?
Authors: Crabbe Jillian , Alexander David A , Klein Susan , Walker Shona , Sinclair John
Published: March 2016

Objectives: To determine the attitudes and experiences of nursing staff in relation to violent and aggressive patients.

Method: A self-administered questionnaire booklet was distributed to 289 nursing staff working in ‘high-risk’ units within two NHS Trusts. In addition to assessing the frequency of violent incidents, the degree of burnout and post-traumatic symptoms experienced were assessed by the inclusion of two standardised measures in the survey, viz, the Maslach Burnout Inventory and the Impact of Event Scale-Revised respectively.

Results: One hundred and fifty six (54%) nurses responded to this survey. Over two-thirds of nurses (72%) had been physically assaulted during the previous two years. The longterm psychological impact of these incidents was not related to whether or not a physical injury was sustained. A positive correlation between burnout and exposure to verbal abuse, threatened assault and violence was demonstrated.

Conclusions: Nurses in these Trusts are exposed to an unacceptable level of violence or aggression from patients, potential implications of which include post-traumatic reactions and burnout. However, nurses are reluctant to report incidents of verbal abuse or threats formally, and they rely upon the support of their colleagues following ‘distressing’ incidents. To protect the wellbeing of their staff, hospital management needs to consider preventative measures, such as training and personal alarms, and improved reporting systems to ensure all incidents are accurately recorded.
Saints-protectors from headache – historical hints of suggestive therapy?
Authors: Skrobonja Ante , Golubovic Vesna , Golubovic Snjezana , Muzur Amir , Skrobonja Ante
Published: March 2016

A short overview of several saints, venerated in Christian tradition as protectors from headache, is offered as an introduction to a more substantial debate on the possibility and value of analysing historical literary and iconographic sources and their interpretation. Headache of possible psychosomatic origin allows (auto) suggestive therapy obtained by the invocation of saints to have had considerable success. This possibility favours the opinion that historical material can be useful not only for cultural-anthropological, but also for modern medical considerations as well.
Eye movements and neurocognitive function in treatment resistant schizophrenia: a pilot study
Authors: Thampi Annette , Campbell Clarke , Clarke Mary , Barrett Suzanne , King David J
Published: March 2016

Objectives: It is increasingly important to develop predictors of treatment response and outcome in schizophrenia. Neuropsychological impairments, particularly those reflecting frontal lobe function, appear to predict poor outcome. Eye movement abnormalities probably also reflect frontal lobe deficits. We wished to see if these two aspects of schizophrenia were correlated and whether they could distinguish a treatment resistant from a treatment responsive group.

Methods: Ten treatment resistant schizophrenic patients were compared with ten treatment responsive patients on three eye movement paradigms (reflexive saccades, antisaccades and smooth pursuit), clinical psychopathology (BPRS, SANS and CGI) and a neuropsychological test battery designed to detect frontal lobe dysfunction. Ten aged-matched controls also carried out the eye movement tasks.

Results: Both treatment responsive (p = 0.038) and treatment resistant (p = 0.007) patients differed significantly from controls on the antisaccade task. The treatment resistant group had a higher error rate than the treatment responsive group, but the difference was not statistically significant. Similar poor neuropsychological test performance was found in both groups.

Conclusions: To demonstrate the biological differences characteristic of treatment resistance, larger sample sizes and wider differences in outcome between the two groups are necessary.
Deterioration in renal function following commencement of citalopram
Authors: Mayfield Neil , Anderson Kay , Rodger Colin
Published: March 2016

We report the case of an 85 year old woman, admitted to hospital with a two month history of a depressive illness. Within one week of commencing treatment with citalopram 20mg daily, she had developed a widespread rash, bilateral ankle oedema and a range of biochemical and haematological abnormalities, including marked elevations of plasma urea and creatinine and increased neutrophil and eosinophil counts. Following withdrawal of citalopram, her physical state returned to normal within two weeks. The episode is suggestive of acute interstitial nephritis triggered by citalopram, a phenomenon not previously reported in association with the selective serotonin reuptake inhibitors.
Costing the hospital-based process of resettling people with learning disability in the community
Authors: Hughes Damien M , McGinnity Maria , Kell John , Kennedy Oscar , Donnelly Michael
Published: March 2016

Objectives: Much has been written about the costs and cost-effectiveness of community care for people with learning disabilities resettled from long stay hospital care. However, comparatively little has been published about the cost of hospital services relating to the preparatory process before eventual resettlement and the disengagement of formal, sustained input from hospital staff. This study describes and costs the input provided by a hospital based multi-disciplinary team into the resettlement of adults with learning disabilities from long stay wards in Muckamore Abbey Hospital in Northern Ireland between 1996 and 1999 (n = 71).

Method: The study employs a retrospective survey design. Information about the nature and frequency of the input of each member of hospital multi-disciplinary team was collected for each former client. According to the level of professional resources expended during the resettlement process, each former client was then categorised into one of three categories. One case was then selected at random to represent each category. A summary of clinical information, a description of the resettlement process and an estimate of the cost of the process was provided for each case.

Results: Approximately 55% of people resettled in the community during the study period did so with a modest degree of input from hospital staff. For 18% resettlement proved to be a demanding and prolonged process, requiring intensive input from hospital staff. Financial costs of the resettlement process ranged from approximately stg£1,500 to stg£8,000, with an average of stg£3,400 for each person.

Conclusion: This study provides evidence of the input by hospital staff into the process of community resettlement of long stay hospital clients and the associated costs. These costs must be included in service budgets if quality care and appropriate service provision is to be maintained in resettlement practice.
Liaison psychiatry in rural general practice
Authors: Russell Vincent , McCauley MacDara , MacMahon John , Casey Sheila , McCullagh Heather , Begley Jillian
Published: March 2016

The recent government health strategy document described the integration between primary and secondary care in Ireland as often poor and outlined plans to redress this deficit. In mental health care, the gradual shift away from institutions over the past four decades has resulted in the GP becoming the most frequent professional contact for people with mental disorders. However, access to specialist opinion is usually available only for the fraction of psychiatric presentations which are formally referred to the psychiatric service.

On-site psychiatric liaison to primary care is commonly practised in other countries but not in Ireland. Research in the area suggests possible advantages for approaches which aim to enhance GPs' psychiatric skills while selectively encouraging referral of more serious disorders. This model has been adopted by GPs and psychiatrists in east Cavan and may be relevant to other similar settings, especially in the context of forthcoming changes in the organisation of primary care services.
Psychiatric consultation to elderly medical inpatients in a general hospital
Authors: O'Neill Conor , O'Connell Henry , Lawlor Brian A
Published: March 2016

Objectives: To determine the reasons for referral of elderly medical inpatients for psychiatric consultation and the appropriateness of such referrals. To determine whether the provision of a consultation service is associated with increases in referral rates over time.

Method: One hundred consecutive referrals seen over an 18-week period were included in the study and data on reason for referral, ICD-10 diagnosis and recommended interventions gathered prospectively. Rates of referral were calculated and compared with a similar study performed in the same location five years previously.

Results: In this location the most frequent reason for referral was for assessment of depressive symptoms (47%). Referrals were generally appropriate and there was a high degree of concordance between reason for referral and psychiatric diagnosis, particularly for depressive symptoms. There was a moderate (22%) increase in referral rates in the five years since the previous study. Concordance rates between reason for referral and psychiatric diagnosis had improved considerably during this period, particularly for depressive symptoms.

Conclusions: Referral rates for psychogeriatric consultation increase over time. Referrals are generally appropriate, and recognition of depressive illness improves. Psychiatric illness may still be under-recognised and increasing workload may indicate a need for more refined models of service delivery.
Computer-assisted learning in undergraduate psychiatry (CAL-PSYCH): evaluation of a pilot programme
Authors: Guerandel Allys , Malone Kevin , Felle Patrick
Published: March 2016

Objectives: To introduce and evaluate a computer assisted learning programme in undergraduate psychiatry (CAL-PSYCH).

Methods: An interactive e-learning environment was created within the University College Dublin portal to assist students in acquiring the necessary skills in undergraduate psychiatry. The pilot phase consisted of providing their lectures on-line on the interactive site. Data were gathered from the last group of students in 2001 (pre-CAL-PSYCH) and the first group of students using CAL-PSYCH in 2002. We included assessment of percentage of students accessing the site, attendance rates at face-to-face lectures and tutorials, and also a feedback questionnaire from students who accessed the site.

Results: All responders had used CAL-PSYCH. Students gave higher ratings for quality and interactivity of lectures compared with the pre-CAL-PSYCH curriculum. Students also expressed enthusiasm about CAL-PSYCH and encouraged us to develop it further.

Conclusions: Computer-assisted learning environments such as CAL-PSYCH provide the opportunity to bring modern e-learning techniques to medical education, and may provide a new model for life-long learning in medicine.
Combining psychiatric and psychological approaches in the inpatient assessment of aggression in a client with moderate intellectual disability
Authors: Grey Ian M , McClean Brian , Kulkarni Leena , Hillery John
Published: March 2016

The literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.
Postnatal depression: a study of the predictive effects of postnatal anxiety
Authors: Teissedre Frédérique , Chabol Henri
Published: March 2016

Objectives: The aim of this study was to evaluate the predictive effects of anxiety, experienced on the third day after delivery, on postnatal depression, evaluated around the sixth week postpartum.

Method: The subjects were 291 postpartum mothers who responded to a certain number of inclusion criteria. The EPDS (Edinburgh Postnatal Depression Scale) and the STAI (State-Trait Anxiety Inventory) were used to evaluate the anxious and depressive symptomatology on the third day postpartum and around the sixth week postpartum. The mothers who obtained scores indicating a probable risk of postnatal depression also completed the Beck Depression Inventory.

Results: We observed that 31% of the mothers showed postpartum blues symptomatology on the third day postpartum. Around the sixth week postpartum 13% of the mothers showed postnatal depression. The results suggest that the level of trait anxiety (β = 0.39; t = 3.64 p < 0.05) and more particularly the intensity of the postpartum blues symptomatology (β = 0.50; t = 6.88 p < 0.001) can predict the risk of postpartum depression. Furthermore, 17.9% of the mothers with postnatal depression around the sixth week postpartum were not detected by the EPDS on the third day after delivery. However, all these mothers were detected by the State-Trait anxiety inventory.

Conclusion: A high level of anxiety during the first few days after delivery may contribute to the mothers' risk of developing postnatal depression. The early detection of high anxiety levels may enable the early screening of mothers at risk of developing postnatal depression.
Long-stay forensic psychiatric inpatients in the Republic of Ireland: aggregated needs assessment
Authors: O'Neill Conor , Heffernan Patrick , Goggins Ray , Corcoran Ciaran , Linehan Sally , Duffy Dearbhla , O'Neill Helen , Smith Charles , Kennedy Harry G
Published: March 2016

Objectives:To profile the current cohort of forensic psychiatric inpatients in the Republic of Ireland, comparing psychiatric healthcare and placement needs of long-stay patients with those more recently admitted.

Method:All forensic psychiatric inpatients in the Central Mental Hospital, Dundrum on a census date were included in the study. Patients and key worker were interviewed using a standardised schedule and validated research instruments. Static and dynamic risk factors for violence including demographic, diagnostic and legal characteristics were supplemented by detailed chart review. Standardised anonymised case vignettes were presented to panels of forensic and community psychiatric multidisciplinary teams who assessed current and future treatment and placement requirements for the cohort.

Results:There were 88 forensic psychiatric inpatients on the census date. Forty-three had lengths of stay over two years (17 over 20 years). Both patient groups were predominantly males with severe mental illness and histories of violent offending. The majority of the long-stay group were receiving regular parole and this group had lower levels of positive symptoms and comorbid substance misuse disorders. Significant gaps in existing rehabilitation inputs were identified. Almost half the long-stay patients were inappropriately placed. Thirty per cent of long-stay patients could be safely transferred to lower levels of security within six months and 63% within three years.

Conclusions:Holding patients in conditions of excessive security impedes rehabilitation and has considerable human rights implications. Almost half of long-stay forensic psychiatric patients in Ireland are inappropriately placed. Barriers to discharge include legislative inadequacies, lack of local low-secure facilities and under-resourcing of community psychiatric services. Such barriers lead to inappropriate utilisation of limited resources and limit access to secure facilities for higher-risk mentally disordered offenders. These findings are of particular relevance in the context of proposed new insanity legislation.
Persistence of psychological problems in adolescence: a one year follow-up study
Authors: James Deborah , Lawlor Maria , Sofroniou Nick
Published: March 2016

Objectives:To examine the prevalence and persistence of psychological problems in older adolescents.

Methods:This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.

Results:Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.

Conclusions:A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.
Social function, clinical symptoms and personality disturbance
Authors: Nur Ula , Tyrer Peter , Merson Stephen , Johnson Tony
Published: March 2016

Objectives:To investigate the relationship between psychiatric symptoms, personality disturbance, and social function.

Method:Longitudinal study of 100 psychiatric patients presenting as emergencies originally entered to a randomised trial of community and hospital-based treatment strategies. Ratings of social function using the Social Functioning Questionnaire, personality status using the Personality Assessment Schedule, and clinical symptomatology using the Comprehensive Psycho-pathological Rating Scale were recorded at baseline with assessment of social function repeated at two, four and 12 weeks. Correlation, regression, and path analysis were performed to test the hypothesis that personality status had more influence than clinical symptoms on social function.

Results:Path and regression analysis showed, that at baseline both psychopathology and personality pathology contributed to social dysfunction equally, but from two weeks onwards personality abnormality contributed to a greater degree than clinical psychopathology. Of the 100, 35 patients had a personality disorder and in these there was a strong correlation between social function scores at baseline and 12 weeks (48% of variation explained) whereas in those with no personality disorder the correlation was much weaker (14%); regression analyses confirmed this conclusion.

Conclusions:Psychopathology and personality status contribute to social dysfunction in patients presenting as emergencies but persistent social dysfunction is more likely to reflect personality pathology than other forms of mental disorder.
Suicide-related bereavement and psychiatric morbidity in the elderly
Authors: Clarke Ciaran S , Wrigley Margo
Published: March 2016

Objectives:We sought to determine whether elderly bereaved patients attending an old-age psychiatry service were more likely to have been bereaved through suicide than through other causes.

Methods:We studied the demographic and clinical profiles of all patients attending an old-age psychiatry service who had experienced the death of an adult child. We compared the causes of the deaths of their children with the most recent figures for the national population.

Results:Deaths from suicide among the children of the bereaved elderly were commoner than for the age-matched national population.

Conclusions:Suicide is more likely than other causes of death to lead to psychiatric morbidity in elderly parents. The needs of elderly survivors should be considered in formulating national strategies for suicide prevention. Further studies are needed on risk factors for complicated bereavement in the elderly.
Luis Simarro and his friends Cajal and Sorolla: three men, one passion
Authors: Fernandez Nieves
Published: March 2016

Luis Simarro, Santiago Ramón y Cajal and Joaquín Sorolla were friends who cultivated art and science in an unhappy Spain. Simarro was the country's leading psychiatrist at the turn of the 20th century, Ramón y Cajal, or simply Cajal as he came to be known in the wider world won the Nobel Prize for his work on the nervous system, and Sorolla is remembered as ‘the Velázquez of light’. All three felt a deep love of Spain and strove to bring freedom, science and the light of truth to their countrymen, each in his own unique way.
A tariff system for nervous shock: introducing the total impact score
Authors: Curran Peter , Miller Paul , Stevenson Michael , O'Neill Tony , Hamilton Stephen , McGowan Iain
Published: March 2016

Objectives: This study was designed to test a proposed relationship between the total impact score (devised by the authors) and the quantum of damages in compensation received by victims of criminal and political violence. In so doing, the authors sought to develop a mathematical formula which could be used to quantify damages in a simple and expeditious manner.

Method: Data on 2,191 victims of violence was collated forming three databases of information, on the incident, on the victim and on the outcomes. A tool of measurement of the psychosocial impact of the traumatic event was designed (the Total Impact Score). Information on a subsample of the 208 survivors of attempted assassination was then selected and the TIS for each individual was calculated and examined for correlations with other variables including the quantum damages awarded.

Results: The TIS was shown to have validity as a measure of the psychosocial impact of a traumatic event upon an individual. The analysis showed a significant relationship between the TIS and quantum awarded. This relationship was used to generate a mathematical formula which could be used to calculate quantum damages in any case. Compensation = £500 × (10(0037t+0.059y) -1), where t is the TIS and y is the number of years after 1985.

Conclusions: The TIS can be taken as a valid tool for quantifying the psychosocial impact of a traumatic event or violent act. The tool consists of a checklist of readily ascertainable outcome variables each of which can be scored and a TIS calculated. From this score the amount of damages can be ascertained. The authors believe that this measurement tool represents a fair and equitable method of calculating a case's worth.
The outcome of treatment in hostels
Authors: Macpherson Rob , Williams Kelwyn , Elliot Helen , Brewer Anne-Marie , McGee Tom
Published: March 2016

Objectives: This paper aimed to examine the outcome of hostel treatment including the effect on hospitalisation rates.

Methods: The work of the four medium/long term Gloucester hostels developed between 1983 and 1993, to provide 24-hour nursed care to ‘new long stay’ patients in Gloucester is described.

Results: Fifty-eight patients with predominately severe mental illness were admitted to the hostels up to 1999, and demographic/illness data is presented. Mean duration of hostel stay was 4.8 years, and one third of patients were readmitted to hospital (most briefly) during their hostel admission, one patient 11 times. Thirty-four patients were discharged from hostels, 29 to less dependent settings, but four referred to hospital care. There was a significant reduction in the number of admissions and duration of hospitalisation in the time between discharge from the hostel to the present or death, as compared with the same time frame for each individual prior to entering the hostel system.

Conclusions: The data adds further support to the potential value of 24 hour nursed care for patients with severe mental illness.