bluuebunny/crossref_metadata_2025 huggingface dataset:
Consultant psychotherapists: who needs them?
Authors: Adams Clare , O'Kane Maria
Published: March 2016

“The idea of a psychotherapeutically informed psychiatry seems such a simple and obvious one and yet the divide between psychotherapy and general psychiatry – between ‘brainlessness’ and ‘mindlessness’ has, until recently, seemed unbridgeable”.

The Psychotherapy section of the Royal College of Psychiatrists has the largest membership in the college. Since psychotherapy became recognised as a discipline within psychiatry in 1975 the Royal College of Psychiatrists has recommended one consultant psychotherapist for each 200,000 of the population. In Northern Ireland there are only 1.9 whole time equivalents rather than the eight expected and in the Republic of Ireland there is none. According to the recent document produced by the Royal College of Psychiatrists' Psychotherapy Faculty Executive Committee in December 1998, The development of psychological therapy services: Role of the consultant psychotherapist, there has been no net growth in the last five years in the numbers of psychotherapists in England and Wales. The future looks equally gloomy in Ireland.

This is rather surprising given that recent government documents have highlighted both the importance and the effectiveness of psychological therapies. There is a growing evidence base underpinning the use of psychotherapy in the management of a wide variety of conditions including psychoses, eating disorders and severe personality disorders.

Psychotherapy has high public acceptability and finds itself in the unusual position of having both government and public demanding the provision of extra psychological therapies, but not receiving the full support of psychiatry and the purchasers of healthcare.
An assessment of the psychoeducational needs of long-term psychiatric patients
Authors: Gibbons Pat , Hogan Grace , McGauran Sheila
Published: March 2016

Objectives: We aimed to identify which illness related topics were of most interest to chronic psychiatric patients in our catchment area service, and to obtain a baseline measure of the amount of knowledge which patients with schizophrenia had about their illness.

Method: Patients attending for a minimum of one year were recruited from the outpatient clinic and day centre. Participants completed three instruments: a brief questionnaire which asked about the details of their diagnosis and drug treatment regimen, the ‘Educational Needs Questionnaire’ (ENQ), and a modified form of the ‘Understanding Schizophrenia Scale’ (USS).

Results: Forty-seven patients with a chronic psychotic illness participated in the study. Despite having attended the service for an average of 14 years, the majority of patients were unable to correctly identify their diagnosis. Most patients were able to name the drugs which they had been prescribed; but were not able to describe the dosage of these drugs. According to the ENQ results, patients expressed most interest in learning about general aspects of their illness, such as ‘how to cope with stress’, and less in how to manage specific illness related symptoms. Similarly, schizophrenia patients were found to know more about general aspects of their illness, such as rehabilitation and non-medical aspects of treatment, than about medication.

Conclusion: Chronic psychiatric patients, especially those with schizophrenia, have very limited knowledge of their illness and its treatment. The focus of psychoeducation should be extended from insight and compliance to include broader ‘quality of life’ issues which appear to be of more concern to patients themselves. Patient participation in psychoeducation can thus be improved by including topics identified by such instruments as the ENQ. It is encouraging that cognitive deficits and negative symptomatology do not seem to prevent long-term psychiatric patients from benefiting from such inputs.
Vampirism and schizophrenia
Authors: Kelly Brendan D , Abood Zainab , Shanley David
Published: March 2016

A case of schizophrenia with vampiric delusions is described. The relevant classical and contemporary literature is reviewed, both in relation to clinical vampirism and the relationship between vampirism and schizophrenia. In patients with vampiric delusions, the possibility of future vampiric behaviour should be considered, and appropriate treatment initiated.
Good practice in attention deficit hyperactivity disorder
Authors: McNicholas Fiona
Published: March 2016

Major advances have been made in ADHD over the years, both in terms of diagnostic validity, different subtypes, comorbidities and treatment options. A comprehensive assessment needs to include medical, developmental and educational history using multiple sources of information and across different settings. In certain cases, additional investigations and neuropsychological testing may need to complement basic physical and neurological examination. The focus of treatment must include not only the core ADHD symptoms but also additional comorbid problems, family and peer relationships, and academic achievement. Treatment should therefore be multi-modal with simultaneous medication, behavioural and educational management. Both diagnosis and treatment response needs to be reviewed regularly to ensure optimal response with minimal adverse side effects.

The increased awareness of ADHD by both clinicians and other professionals has resulted in a huge increase of referrals for assessment, diagnosis and treatment. In particular, families are becoming increasingly knowledgeable about the disorder and are rightly requesting adequate assessment and treatment of their children. It is therefore essential that all clinicians are equally knowledgeable about the advances in this area and offer a service to families which represents good clinical practice. This article reviews what constitutes good clinical practice in ADHD.
Depression among postnatal women in an urban Irish community
Authors: Cryan Elizabeth , Keogh Fiona , Connolly Eibhlin , Cody Stasia , Quinlan Ailis , Daly Ian
Published: March 2016

Objectives:To estimate the prevalence of postnatal depression in a community sample of women in a disadvantaged urban area in West Dublin, and to examine the factors which may be associated with it.

Method: All women who had a live birth in the area over a one year period were identified (944) and the self-rated Edinburgh Postnatal Depression Scale (EPDS) was distributed to those who could be contacted by the public health nurses. Those scoring in the depressed range (> 12) were compared to non-depressed for age, marital status, employment, parity, presence of a confidant, mode of delivery, previous miscarriage and previous psychiatric history.

Results: Contact was made with 596 women and 377 responded. Responders were older and more likely to be first time mothers, but there was no significant difference between responders and eligible population for marital status. One hundred and eight women (28.6%) scored in the depressed range. Ten sociodemographic and clinical variables were entered into a logistic regression. Scores over the threshold (> 12), suggesting clinical depression, were significantly associated with four variables, lower age, absence of a confidant, previous miscarriage and previous treatment for depression by a GP.

Conclusions: A high prevalence of postnatal depression of 28.6% was reported, which may be associated with overall high levels of social disadvantage in this sample. There were implications for the targeting of resources into such areas. The associated factors are discussed.
Psychopharmacological treatment of adolescent and adult attention deficit hyperactivity disorder
Authors: Fitzgerald Michael
Published: March 2016

Adult ADHD is becoming a rather ‘firm’ diagnosis in adult psychiatry practice. Nevertheless it is a diagnosis that is often missed which leads to unnecessary distress to patients. This paper sets out the treatment possibilities.
Rehabilitation psychiatry
Authors: Mountain Deborah A
Published: March 2016

Rehabilitation services are changing across Britain. The focus of service developments appears to be in relation to community teams and assertive outreach. This leaves the question of which direction rehabilitation services are heading. As patients move into the community from long stay wards as part of the process of bed closures and resource transfer, rehabilitation services are left with changing patient characteristics. In addition, patient characteristics in rehabilitation vary between Trusts. This article explores and expands on these themes.
Psychiatric and medical co-morbidity in mitral valve prolapse
Authors: Gonzalez Efrain A , Pimentel Claudia , Natale Ruby A , Toll Benjamin A , Soffer Ariel , Gralnik Leonard
Published: March 2016

Objective: Significant controversy continues to exist in the empirical literature regarding the diagnosis and treatment of mitral valve prolapse (MVP). In addition, there is also inconsistency in the correlation of anxiety disorders as co-existing with MVP, as well as cause and effect issues in terms of the role of the autonomic nervous system, MVP and panic attacks. Recent studies suggest that the co-morbidity of an anxiety disorder and clinical depression appears to increase the likelihood of MVP in predisposed patients. The objective of this review was to examine, clarify, and further define the medical and psychiatric aspects of MVP.

Methods: A literature review was conducted on empirical studies and reviews examining MVP.

Results: It was found that although MVP is highly correlated with psychiatric disorders, the lack of adequate control groups and clear criteria for a diagnosis of MVP in most empirical studies examining these associations make it difficult to determine the relationship between MVP and psychiatric disorders.

Conclusions: Suggestions for further research in the areas of depression and personality characteristics are offered. It is also suggested that the use of control groups from populations with cardiac disorders and a better definition of MVP will clarify many of the problems in empirical studies aiming to determine the relationship between MVP and psychiatric disorders.
Buprenorphine detoxification treatment for heroin dependence: a preliminary experience in an outpatient setting
Authors: Williams Hugh , Remedios Andrew , Oyefeso Adenekan , Bennett Jennifer
Published: March 2016

Objectives: The aim of the study was to evaluate buprenorphine as a detoxification agent for heroin dependence in an outpatient setting. Specifically we sought to establish the rate of completion of detoxification and retention in treatment, the duration of successful detoxification and dose requirements.

Methods: The study was an open prospective evaluation of routinely collected clinical data on the first 60 consecutive heroin dependent patients who underwent buprenorphine detoxification. A flexible dosing regime was adopted with the dose of buprenorphine being adjusted daily against the previous day's withdrawal symptoms.

Results: The majority of patients (40 (67%)) completed detoxification. The median duration of treatment for completers was 17 days (range 9-30 days) with 90% of detoxification episodes completed within 21 days. Patients were commenced on initial median dose of 4mg buprenorphine (range 2mg-6mg) and the median stabilisation dose for the sample was 10mg daily (range 6mg-14mg). The median final dosage of buprenorphine required by patients retained in treatment was 1.2mg (range 0.4mg-2mg). We found older patient age to be a significant predictor of treatment completion.

Conclusions: Buprenorphine was an acceptable and a feasible outpatient detoxification treatment option for heroin dependent patients. Based on the study findings we propose a standard 21-day fixed-dose detoxification schedule.
Down's syndrome, dementia and macrocytosis
Authors: Prasher Vee , Viswanathan Jay , Holder Roger
Published: March 2016

Objective: No definitive peripheral biological marker has yet been found to correlate with Alzheimer's disease (AD). This study investigated the role of macrocytosis as a marker which could significantly improve our understanding of AD in the Down's syndrome (DS) population.

Methods: This study investigated the possible association between raised mean corpuscular volume (MCV) and AD in 150 adults with DS over a five year study period.

Results: A raised MCV is common in the DS population. A statistically significant association between a further elevated MCV and clinically diagnosed AD in adults with DS was found.

Conclusions: The findings suggest that further research into the association between macrocytosis and DS could improve our understanding of the underlying biological mechanisms of AD. The measurement of MCV should be undertaken in all DS individuals with a diagnosis of possible or definite dementia. A significant raised MCV (above 97fl for males and 99fl for females) may further improve the clinical diagnosis. A single MCV measurement, however, cannot be recommended as a diagnostic test for AD in adults with DS.
Self-poisoning patients in the general hospital: the frequency and nature of their consultations with the general practitioner
Authors: Hasan S Masood-ul , Owens David
Published: March 2016

Objectives: To update the 20 year-old maxim that the majority of patients who undertake self-poisoning have recently seen their general practitioner, and to determine the patients' expressed reasons for consulting the doctor.

Methods: Two-stage cross-sectional survey: first, to find out from all self-poisoning patients whether they had recently attended their general practitioner; second, to determine, in a sub-sample of those who had attended, why they made their most recent consultation. The subjects were consecutive adult patients who were admitted to the general hospital in the City of Bradford as a consequence of self-poisoning.

Results: Overall 125/237 (53%) patients reported a consultation with their general practitioner in the previous month, and 61 of the 237 (26%) were within the last week. Patients recounted that their main expectations when consulting were to do with prescriptions, sick-notes and physical check-ups.

Conclusions: Although many of those who undertake self-poisoning consult their general practitioner shortly beforehand, a preponderance of physical complaints may render anticipation of the self-poisoning a difficult task.
Catastrophic reaction following the separation of adult twins
Authors: Dunlop Caroline , Williams Kelwyn , Holloway Amy
Published: March 2016

We describe a case of adult twins presenting simultaneously with profound psychological disturbance following sudden separation. Formulation is made of a catastrophic adjustment reaction manifesting as depression in one sibling and anxiety in the other. An alternative possibility of acute onset psychosis in one or both of the twins is discussed.
The use of HoNOSCA in a child and adolescent mental health service
Authors: Manderson Julie , McCune Noel
Published: March 2016

Objectives: To assess the health and social functioning of patients attending a Child and Adolescent Mental Health Service (CAMHS) and to measure the impact of attendance using the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA).

Method: HoNOSCA was completed on 73 consecutive patients attending for initial assessment with a review assessment being completed after six months or at discharge from the clinic if this occurred sooner on 53 of these. The impact of attendance at the clinics was determined by comparing initial and review mean HoNOSCA Scores.

Results: Of the 53, 66% were male and 34% female. Boys were more highly rated with regard to aggressive behaviour, performance in peer relationships and family life relationships whilst girls were rated as having more nonorganic and emotional symptoms. Older children showed the highest rates of poor school attendance, non accidental (self) injury and emotional problems while younger children showed the greatest aggressive behaviour and language skill problems. An improvement in the total HoNOSCA score from initial assessment to review was seen in 92%. There was an improvement in the HoNOSCA mean score from initial assessment to review.

Conclusions: Age, sex and symptom profiles of patients attending the service were similar to other CAMHS. Attendance at CAMHS produces improvements in patient outcomes over a six month period as measured using HoNOSCA, which proved to be a useful if somewhat time consuming tool.
ECT and etomidate-induced seizure-like activity
Authors: McCauley MacDara , Russell Vincent
Published: March 2016

Following the withdrawal of methohexitone from the market place psychiatrists and anaesthetists have been forced to seek out alternative anaesthetic agents for ECT. We report a case of etomidate-induced seizure-like activity. We review the literature on ECT and anaesthetic agents and discuss the alternatives available in accordance with a statement by The Royal College of Psychiatrists.
Telepsychiatry in a Child and Adolescent Psychiatric Service
Authors: Browne David , Reilly Michael , Bradley Oonagh
Published: March 2016

Objectives: To carry out a survey on the use of video conferencing equipment by a rural child psychiatric multidisciplinary team and to determine what impact the introduction of this equipment had on service provision.

Method: Several aspects were studied including user satisfaction and estimations of cost saving, on the basis of avoidance of travel to and from the regional base in Galway. A questionnaire was also developed to determine whether alternative contact would have been made if if this new technology were not in place.

Results: The results of the initial six months following commencement were investigated. Use of the equipment was attempted 17 times during this period. Most members of the child psychiatry team participated in its use. Visual problems accounted for 66.7% of reported technical difficulty and 88.9% of users rated their level of satisfaction with the equipment as ‘Satisfied’ or ‘Very Satisfied’.

Conclusions: Apart from the start-up cost implications of installing this equipment, it satisfied its aim of increasing contact between the rural service and St Anne's Children Centre in Galway. The equipment was easy to use and for the most part reliable.
Oedipism: Auto-enucleation in a schizophrenic patient
Authors: Murphy Mary , Nathan Malavika , Lee Edward , Parsons Brian , Gunasekera Lal
Published: March 2016

We report the rare occurrence of subarachnoid haemorrhage secondary to probable auto-enucleation of the orbit (oedipism) and we document management of these co-incident pathologies in a schizophrenic patient.

A 67 year old schizophrenic woman suffered a subarachnoid haemorrhage and presented with seizures following enucleation of her right eye. Initial efforts should focus on investigation and management of the subarachnoid haemorrhage. Management of Oedipism must include collaboration between psychiatrists, neurosurgeons and opthalmologists, focusing on management of the subarachnoid haemorrhage with precautions to prevent further self-injurious behaviour.
Borderline personality disorder and clozapine
Authors: Rutledge Emer , O'Regan Mary , Mohan Damian
Published: March 2016

Clozapine is an atypical anti-psychotic medication that has proved useful in the management of both psychotic and mood disorders and that has been shown to decrease aggression and the risk of suicide, which suggests that clozapine may be useful in the management of severe borderline personality disorder. Here we present the case of a 36 year old female with severe borderline personality disorder with symptoms of psychosis, aggression and violence. We discuss how treatment with clozapine resulted in a marked clinical improvement in this patient.
Dermatitis artefacta: an unusual diagnosis in psychodermatology
Authors: Motherway Lee , Gallagher Damien , Guerandel Allys , Kirby Brian , Malone Kevin
Published: March 2016

We report the case of a 22 year old female diagnosed with dermatitis artefacta. This is an uncommon diagnosis and provides a unique therapeutic challenge for psychiatrists and dermatologists alike. We describe how early intervention and a close collaborative approach is central to securing a favourable outcome for patients.
An exploration of the relationship between social support and depressive symptoms in schizophrenia
Authors: Simms Jane , Mulholland Ciaran
Published: March 2016

Objective:Depressive symptoms in schizophrenia have previously been associated with a perceived lack of social support. The aim of this study was to explore the relationship between perceived social support and depressive symptoms in schizophrenia; to assess the psychological wellbeing of their carers; and to examine the quality of the relationship between the patients and their carers.

Method:Individuals with schizophrenia (n = 17) were assessed on the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), a measure of perceived social support, the Significant Others Scale (SOS) and the Quality of Relationship Inventory (QRI).

Results:The mean score on the BDI for patients fell within the moderate-severe range and the mean range on the BHS fell within the moderate range. Family and friends were perceived as supportive resources by patients. There was no significant relationship between patient depressive symptoms or hopelessness and perceived social support. Carers of patients did not report high rates of depressive symptoms or hopelessness.

Conclusions:These findings do not support the previous finding of an association between depressive symptoms and a perceived lack of social support in schizophrenia.
Meeting standards set for non self-harm presentations to emergency departments
Authors: Mullins Diane , MacHale Siobhan , Cotter David
Published: March 2016

Objectives: The commonest psychiatric presentation in most emergency departments (EDs) is deliberate self-harm. However, there are other significant categories of psychiatric presentation which include alcohol and substance misuse, acute psychosis and mood disorder. In addition to the NICE Guidelines for deliberate self-harm, there are good practice guidelines available for the management of other psychiatric attendances to the ED. The aim of this study was to identify the psychiatric attendances other than deliberate self-harm to Beaumont Hospital ED over a 12-month period with the objective of studying the rates and characteristics of attendances and to investigate whether good practice guidelines were met.

Method: From a total of 657 psychiatric attendances other than deliberate self-harm which were recorded, data was collected on demographics, provision of a psychosocial assessment and adherence to good practice guidelines.

Results: Alcohol (38%) was the most common reason for presentation. Of the total number of attendees, only 44% received a psychosocial assessment compared to 59% of attendees who had presented following deliberate self-harm during the same 12-month period.

Conclusions: The attendees who did not receive a psychosocial assessment represent a vulnerable group in which the levels of psychosocial assessment need to be improved in order to meet good practice guidelines standards of care.
First episode psychosis and an underlying cerebellar tumour
Authors: Nkire Nnamdi , Barry Helen , Russell Vincent
Published: March 2016

We report on the case of a middle aged lady who was referred by her GP with what appeared to be a case of first episode psychosis. Following assessment and investigation an underlying cerebellar tumour was identified. Our aim is to draw attention to the ongoing debates regarding the possible role of the cerebellum in psychosis and cognition and on neuroimaging as a diagnostic modality in cases of first episode psychosis.
Two psychiatric presentations linked with ‘head shop’ products
Authors: Uhoegbu Chimdi , Kolshus Eric , Nwachukwu Izu , Guerandel Allys , Maher Caroline
Published: March 2016

We report two cases of acute onset and rapid resolution of psychotic symptoms, the first following oral ingestion and the second following intravenous injection of some head shop products (HSPs). Both were associated with autonomic instability and negative results on urine toxicology screening using standard techniques. They highlight the potential dangers of managing such cases in acute stand-alone psychiatric units. Recent advance in characterising some HSPs by toxicology screening is also discussed.
Benzylpiperazine-induced acute delirium in a patient with schizophrenia and an incidental temporal meningioma
Authors: Tully John , Hallahan Brian , McDonald Colm
Published: March 2016

Benzylpiperazine is a psychotropic compound that has been widely available until recently from licensed premises such as ‘head shops’. This report describes a case of a 48 year old man with schizophrenia who developed an acute delirium secondary to benzylpiperazine use, although he initially presented as a diagnostic conundrum. Investigation of his delirium unearthed a temporal meningioma which appears to be an incidental finding. This is the first documented case of delirium due to benzylpiperazine use. Benzylpiperazine has significant abuse potential and psychiatric complications. Its sale and possession have recently been made illegal in Ireland, which may limit its abuse in the future.
Improving monitoring for metabolic syndrome using audit
Authors: Murtagh Alan , Petrovici Radu , Wong Wendy , Obadan Curtis , Solanke Olufemi , Nnabuchi Emmanuel , Kilbride Kevin
Published: March 2016

Audit has been defined as “a quality improvement process that seeks to improve patient care and outcome, through systematic review of care and comparison with explicit criteria, followed by the implementation of change”. As of May 2011, under the Medical Practitioners Act 2007, doctors are legally obliged to join in professional competence schemes, following requirements set by the Medical Council. These include the obligation for doctors to conduct one clinical audit per year. In Ireland and elsewhere, audit provides an opportunity for services to create an “environment in which clinical care will flourish”.
Reducing the costs of chronic somatisation
Authors: Williams Christopher , House Allan
Published: March 2016

We report the case of a 48 year old woman who presents with a 25 year history of somatisation disorder. She has ten volumes of notes from four hospitals in one city which together weigh almost 10kg. She has been under the care of ten hospital specialities, had eleven operations, with 77 admissions and a total of 856 days in hospital over a period of twenty-five years. No physical diagnoses can satisfactorily explain her presentations which have been accurately costed to a total of over £250,000 as a conservative estimate.

Somatisation disorder is a chronic illness with financial, medical and personal costs. We report in detail recurrent dangers and pitfalls which arose during her hospital contact. By undertaking a case note review, contacting all the physicians involved and writing a “Key” summary letter outlining the contribution of psychological factors to her problems, her annual health care costs were reduced from a total of over £10,000 a year to a little over £2,000 after psychiatric intervention and the appointment of one physician to take overall charge of her case. Implications for service provision are discussed.
Student
Authors: Breathnach Caoimhghin S
Published: March 2016

William Sealy Gosset [1876-1937] was a brewer in Arthur Guinness and Co. Dublin from 1899 to 1935 when he moved to London. In 1907, writing under the nom de plumeStudenthe published his paper on “the probable error of a mean” which was later developed by R A Fisher intoStudent's test of significancenow in everyday use in biology and industry.
Blood groups in dementia (SDAT) — a pilot study
Authors: Mathew V M
Published: March 2016

Objective:Various studies have shown an association between ABO blood groups and both physical and mental illness. This pilot study was conducted to find out whether there is any association between ABO blood groups and senile dementia of Alzheimer's type.Methods:The sample was selected from 107 patients admitted to the psychogeriatric assessment unit of the district psychiatric hospital over a period of one year. All Caucasian patients of United Kingdom origin above the age of 70 with confirmed diagnosis of Alzheimer's dementia according to DSM-III criteria who had developed dementia after the age of 65 were included (N = 33); 74 patients were excluded for various reasons.Results:Out of the 33 patients there were 21 (64%) with group A, 3 (9%) with group B, 9 (27%) with group O and none with group AB blood. Among the United Kingdom population there were 79,334 (42%) with group A, 16,280 (9%) with group B, 88,782 (47%) with group O and 5,781 (3%) with group AB blood (p = 0.038).Conclusions:Although the number of cases were not large, the results of this study suggest that the prevalence of type A blood group was greater and O was less for Caucasian Alzheimer's subjects than for the general population.
Psychosis following lorazepam withdrawal
Authors: Sheehan John D , Shelley Rory K
Published: March 2016

A sixty three year old woman developed an organic psychosis after stopping lorazepam. She had taken a high dosage of the drug for 4 years but had discontinued it gradually in reducing doses over six months. It suggests that serious withdrawal reactions may still occur despite gradual cessation and highlights the importance of total dose ingested as a predictor of withdrawal phenomena.
Ictal aggression in severely mentally handicapped people
Authors: Creaby Mary , Warner Mary , Jamil Nahla , Jawad Sudad
Published: March 2016

Objective: To study the relationship between epilepsy and aggression in a population of severely mentally handicapped people. Methods: Comparing epilepsy and aggression variables in people with epilepsy without aggression, people with aggression without epilepsy, and people with both. The epilepsy variables were: seizure frequency, classification, anticonvulsant drugs, therapeutic drug monitoring, and neuroleptic drugs. Aggression variables were: frequency, direction, type, and neuroleptic drugs. Results: Prevalence of aggressive behaviour was similar in people with and without epilepsy (36%). Partial seizures were less prevalent in people with epilepsy and aggression. People with epilepsy were more likely to manifest unprovoked aggression directed against property. Conclusion: Some episodes of aggressive behaviour in people with epilepsy may be ictal in origin.
Macha's curse: an Ulster pedigree
Authors: Montgomery Robert C , Nevin Norman C , King David J
Published: March 2016

Two individuals, a father and son with idiopathic intestinal pseudo-obstruction (IIPO), a familial visceral neuropathy, and major depressive illness are presented. In both the bowel symptoms preceded the onset of the depressive illness – the bowel symptoms presenting in mid-adolescence and the depressive illness presenting in middle age. Both patients required numerous laparotomies and both were treated with a series of ECTs. Both developed vitamin B12deficiency anaemia and other evidence of malabsorption. At post-mortem both patients showed evidence of distension of the small bowel with volvulus. An extensive pedigree of both conditions overlapping in two inter-related families now extending to the fourth generation with 28 children under the age of 30 is described. Pending further investigation and genetic studies we postulate a possible common neurotransmitter pathology and recommend further neurochemical and histopathological studies of the myenteric plexus in IIPO. Furthermore, the genetic locus of familial IIPO might provide a genetic marker for some forms of primary affective disorder.
Manic-depressive illness — II: treatment outcome in bipolar disorder subtypes
Authors: McKeon Patrick , Manley Patrick , Swanwick Gregory
Published: March 2016

The treatment outcome of 100 bipolar disorder patients (B.P.) was examined retrospectively to determine whether bipolar subtypes had a differential prophylactic response to lithium, carbamazepine, neuroleptics and antidepressant drugs when these treatments were given in a predetermined sequence. Sixty-eight per cent of 53 B.P.-I patients with a mania-depression-normothymic-interval (M.D.I.) sequence of mood changes had a good response to lithium, and all but one of the remainder responded with the addition of carbamazepine or an antidepressant. While only 17% of 12 unipolar manic patients achieved prophylaxis with lithium and a further 17% when carbamazepine was added, the other 66% remained normothymic when a neuroleptic was prescribed with lithium. Of the seven rapid cycling patients where depression preceded mania, 28% had a good prophylactic effect with lithium, a further 28% when a tricyclic antidepressant was added and 14% with lithium and carbamazepine. None of the 18 rapid cycling M.D.I. group had a good response to lithium, but 39% stabilised when carbamazepine was added to lithium. Twenty-eight per cent of this group failed completely to respond to any of the treatments used. Neuroleptics increased the severity and duration of depressive phases for all subtypes except the unipolar mania group.
The role of the child psychiatric ward in health care: experiences with different types of admissions over a period of twenty-one years
Authors: Gray Colin , Chisholm Douglas , Smith Patricia , Brown Madeline , McKay Christina
Published: March 2016

The concept of the child psychiatric unit is considered. The character, capacities and activities of one unit are described and some features of the admissions over its first 21 years are discussed in relation to the findings of other studies. Among the factors considered are the patients' presenting diagnoses, their sex, their physical health and their length of stay in the Unit. Some possible future directions for the Unit are discussed, and the pattern of work over the two decades covered by the study is related to current and future requirements. It is suggested that for several categories of disorder, a child psychiatric unit offers unique advantages in both assessment and treatment.
Emotionalism in Parkinson's disease
Authors: Madeley Peter , Biggins Colin Anthony , Boyd Jane L , Mindham Richard H S , Spokes Ernest G S
Published: March 2016

Forty seven patients with idiopathic Parkinson's disease (PD) were assessed to ascertain the presence or absence of emotionalism. Thirty eight per cent of the sample reported being more tearful since the onset of PD than previously. Five patients (10.6%) were found to exhibit emotionalism according to specified criteria. Emotionalism in PD is not solely associated with lowered mood or global cognitive impairment.
The manic readmissions explosion in Edinburgh
Authors: Mander Anthony J
Published: March 2016

Between 1975 and 1985 there was a significant increase in the total number of admissions for mania and schizophrenia and a significant decrease for personality disorder to the Royal Edinburgh Hospital. All admissions for 1975 and 1985 in these three groups were subsequently examined retrospectively. The number of first admissions for personality disorder dropped significantly and the number of readmissions for mania increased significantly. Patients with schizophrenia and personality disorder had shorter admissions and a shorter relapse-free interval in 1985 but the overall effect of these changes was to reduce the total number of bed days used by these groups. For mania there was no change in admission length but significant shortening of the relapse-free interval leading to a substantial increase in total bed days used. There was no evidence that a change of diagnostic practice had occurred or that patients admitted with mania in 1985 were less ill. Although there were changes in referral and after-care arrangements, these were not specific to mania. Further work should specifically address the issue of aftercare arrangements and their influence on prognosis in mania, and the resource implications of the continuing rise in admissions.
Reversal of roles in folie à deux associated with manic-depressive illness
Authors: Ryan C M Dympna , Khan Shaukat A , Warwick Hilary M C , Mindham Richard H S
Published: March 2016

An example of folie à deux with an uncommon clinical picture is presented. It concerns two spinster sisters, with no past psychiatric history, who became simultaneously manic while on holiday. The “Principal” was clearly deluded; the “Associate” shared these abnormal beliefs. After recovery and eighteen months later, one became depressed and the other shared her suicidal ideas, but this time the roles of the “Principal” and “Associate” were reversed. The shortcomings of the ICD10 and DSM-IIIR in classifying this syndrome are highlighted.
Korsakov
Authors: Breathnach Caoimhghin S
Published: March 2016

Alcoholic polyneuritis with characteristic mental symptoms was described by Sergei Korsakov in 1887; Wernicke confirmed and extended his observations, and modern high-resolution magnetic resonance imaging techniques make it possible to relate the confabulatory amnesia with abnormally small mammillary nuclei.
Community mental health care ideology and the mental health care professional
Authors: Nolan Clodagh
Published: March 2016

Objective: To measure the level of commitment by mental health care professionals within the Eastern Health Board to the concept of community mental health.

Methods: An adapted version of the Baker-Schulberg Community Mental Health Ideology Scale was administered to a random sample of professionals (psychologists, psychiatrists, psychiatric nurses, community psychiatric nurses, social workers and occupational therapists).

Results: Psychiatrists within this study had the lowest scores indicating the least level of commitment, and were also found to focus upon extrinsic issues, such as economic barriers, as possible obstacles to the development of a community mental health service in Ireland.

Conclusion: Policy and decision making committees need to address the balance of the mental health care professionals represented on those committees.
Resolution of panic disorder during pregnancy
Authors: Curran Stephen , Nelson Terry E , Rodgers R John
Published: March 2016

A patient with severe long-standing panic disorder who made a full recovery whilst pregnant, only to relapse during the postpartum period, is presented. Sex steroids may have a role in the aetiology and management of panic disorder. This is potentially an important area which requires further research.
Conversion disorder, sexual abuse and interprofessional communication – some lessons to be re-learned
Authors: Kelly Ciaran , Moran Thomas , Myatt Paul
Published: March 2016

We describe an adolescent boy who presented with physical symptoms, for which no organic cause could be found. He proved a challenge to medical management and we highlight the reluctance to consider making a diagnosis of conversion disorder. Significant medical contact since infancy, a history of sexual abuse, and current stressors are considered as having contributed to his presentation. We discuss general issues in the management of conversion disorder and consider the risks of neglecting this diagnosis as technological advances are made and sophisticated investigations are relied upon.
Psychiatrists and family therapy: impressions at the interface of ideology and practice
Authors: Sheerin Declan Finnian
Published: March 2016

The reception of family therapy into a psychiatric profession that during the 50s was inclined to sanctify the individual psyche rather than the system inevitably polarized the profession. Psychiatrists contribute a significant referral imput to family therapy services in public health settings and therefore their knowledge of and disposition towards family therapy are influential elements of the context within which family therapy is practised, (i) This paper, through the use of a questionnaire, addresses qualitatively the prevailing attitudes and conceptualizations of psychiatrists working in the Eastern Health Board, Ireland, regarding family therapy, (ii) It looks at these opinions in the context of recent research findings on the efficacy of family therapy and highlights a famine of concise information regarding specific family treatment modalities, (iii) Finally it looks at the difficult relationship that exists between the old and the new epistemologies, which may be termed the ‘conservative and the impetuous’, and the implications for legitimate research into family therapy in the context of a consumerist-driven health service and at the interface of conflicting ideologies.
Childhood behavioural problems and maternal depression in general practice
Authors: Cody Diana Day , Fitzgerald Michael
Published: March 2016

Childhood behavioural problems and social competence in children of mothers attending a Dublin general practice were studied; they were found to have a prevalence of 30%, and to be associated with maternal depression, and marital disharmony. This relationship is explored, and the possible implications for management in a general practice discussed.
Community-Based Training Programmes For Young Offenders: Perceptions of Programme Impact
Authors: Shorts Ivor D.
Published: March 2016

This paper presents the programme perceptions of male young offenders involved in 2 Dublin community training workshops. Most of the sample indicated that they perceived their training to have had an overall positive impact (ranging from a moderate to a very substantial extent) in various areas of skills and personal development. Those emerging with a higher level of self-confidence, predictably, had also perceived themselves to have benefited more in almost all areas. Ambivalent predictions of the sample in respect of their future employment and re-offending tended to be associated with fewer perceived programme benefits, than were optimistic predictions.
Psychological Distress & Attitude to Authority in a Sample of Irish Adolescents
Authors: Williams H , Fitzgerald M , Kinsella A
Published: March 2016

92 adolescents (mean age 13.8 yrs) at a North Dublin school completed the GHQ - 30 and the attitude to authority scale. A high level of psychological distress (as measured by the GHQ - 30) was found, with 44% of the sample reporting 6 or more symptoms. The majority of students (84%) however expressed pro-authority feelings. A negative correlation was found between the level of distress and positive attitude towards parents. The possible clinical relevance is discussed
A liaison psychiatry experience of epilepsy
Authors: Byrne Alan P
Published: March 2016

Of three hundred and sixty-one cases seen in a liaison psychiatry service over a twelve-month period, fifteen cases presented with psychiatric symptoms related to epileptic activity, or the treatment thereof. Seven new cases of epilepsy were diagnosed on the basis of primarily psychiatric phenomenology. The fact that twenty-five per cent of patients with epilepsy seen during this period had been incorrectly diagnosed gives cause for concern, and examination of the factors which caused diagnostic difficulty in these cases reveals details of interest to practising clinicians.
Christmas census at a district general hospital psychiatric unit
Authors: Ballard Clive , Bannister Carol , Davis Rachel , Handy Sumi , Cullen Paul , Chithiramohan Ramalingam
Published: March 2016

We present a descriptive study discussing the reasons why patients remained as in-patients within the psychiatric unit over the Christmas period. In over 50% of cases continuation of in-patient stay was necessitated by the severity of mental illness. However, a significant minority of patients were unable to leave because of either poor family support or reduced input from the community mental health services. There was some evidence of Christmas good will influencing admission policy with a significantly greater number of patients admitted with alcohol problems over the week before Christmas all of whom were lonely and expressed a preference to be in hospital.

A more long term problem was also evident as an important minority of patients' hospital stay was unnecessarily prolonged because of unavailability of suitable community placements.
Serum immunoglobulins in tardive dyskinesia — implication for pathogenesis of the syndrome
Authors: Youssef Hanafy
Published: March 2016

Levels of immunoglobulins were measured in 32 schizophrenic patients with tardive dyskinesia and 34 schizophrenic patients without tardive dyskinesia. The duration of neuroleptic treatment in years was similar in the two groups. The serum immunoglobulin concentrations (mg%) were found to be significantly different in the two groups; IGA and IGM levels were higher in patients with tardive dyskinesia. The present results may be explained on the basis of dysfunction of the immunological system in tardive dyskinesia.
Cerletti
Authors: Breathnach C. S.
Published: March 2016

Electroconvulsive therapy was introduced in 1938 by Ugo Cerletti (1877-1963) of Rome in association with “young Dr. Bini”. Cerletti's training and his development of the electrical technique as an alternative to chemically-induced convulsions are briefly outlined.
The early signs of manic relapse after lithium discontinuation and their clinical implications
Authors: Mander A J
Published: March 2016

The earliest signs and symptoms of manic relapse in eight bipolar patients after lithium discontinuation were changes in talkativeness, motor performance, self-confidence and sleep pattern; only two patients reported a change in mood. These changes were initially subtle and did not occur in patients who stayed well after stopping lithium. The lack of affective symptoms might result in clinicians ascribing the changes to the removal of the sedative and cognitive slowing properties of lithium, rather than signs of an impending relapse; similar changes may well occur in patients whose relapse is not associated with lithium discontinuation. Prompt early treatment with lithium (and additional thioridazine in some cases) resulted in only two patients requiring readmission, both for ten days. It is concluded that such symptoms may indicate an impending relapse and prompt treatment is recommended.
The secondary sexual characteristics of the brain
Authors: Breathnach C S
Published: March 2016

In the avian cerebrum and in the spinal cord, sympathetic ganglia, hypothalamico pre-optic area and cerebral cortex of the rat sexually dimorphic' nuclei are clearly recognisable. Similar differences have been described in the human brain. Morphometric analysis has shown a sexually dimorphic nucleus in the pre-optic area. There is continuing controversy over differences in the size and shape of the corpus callosum, but there is accumulating evidence of cerebral asymmetry with more focal representation of language and praxic functions in the left cerebral hemisphere in females. The various sensory modalitites also show gender differences. The significance of these secondary sexual variations in brain structure resides in the developmental and behavioural characteristics of the underlying neural circuits.