bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-registration of deaths as a source of error in mortality data in the Irish Republic
Authors: Connolly John F , Cullen Anne , Scott Josephine , Smithwick Deirdre
Published: March 2016

Objectives: To ascertain whether or not there had been any improvement in the registration of deaths in Co. Mayo, Ireland, since 1970. At the time is was shown that 7.5% of deaths, in a sample of parishes in the west of Ireland had not been registered.

Method: A list of all those who died and were buried in Co. Mayo in 1992, was obtained and compared with a list of deaths registered in that and subsequent years.

Results: One hundred and twenty eight deaths (11.5%) occurring in the county in 1992 had not been registered by the time of this study in 1997.

Conclusions: Non-registration of deaths continues to pose serious problems for research and for the planning of health services. It is suggested that the government introduce legislation to address the issue. Registration of deaths should be standardised throughout the EU.
Health gain for epilepsy associated with learning disabilities psychiatric care
Authors: Beber Elizabeth , Bailey Nicola M , Cooper Sally-Ann
Published: March 2016

Objectives: The establishment of a learning disabilities psychiatric service for people living in north Northamptonshire presented the opportunity to measure the clinical effectiveness of epilepsy care provided by learning disabilities psychiatrists.

Method: Baseline and one year outcome health measurements were made on a group of adults with learning disabilities and epilepsy who received learning disabilities psychiatric care (n = 42), and also on a group of adults with learning disabilities and epilepsy who did not receive care from learning disabilities psychiatry -(n = 12). Comparisons were made between baseline and outcome measurements for those who did, compared to those who did not receive psychiatric care. The comparison group was included as conducting a baseline health assessment may itself improve the quality of healthcare by raising awareness of the issue (in a way that is unconnected to care provided by the psychiatrist).

Results: Learning disabilities psychiatric care was found to effect reduced seizure frequency, with a reduced frequency of drug side-effects and reduced frequency of polypharmacy. The type of the person's seizures was more likely to be determined, medical reviews and appropriate blood test monitoring conducted and active interventions made to improve seizure control and to withdraw unnecessary drugs, if the person was receiving learning disabilities psychiatric care. Almost all of these results were highly statistically significant.

Conclusion: It is important that learning disabilities psychiatric care is available to this group, as it has been demonstrated to effect health gain.
Personality traits in parents of people with autism
Authors: O'Hanrahan Susan , Fitzgerald Michael , O'Regan Myra
Published: March 2016

Objectives: This study set out to explore if there were measurable personality characteristics specific to parents of people with autism.

Method: Parents of 12 people with a DSM-III-R diagnosis of autism presented for the study. Each of the people with autism were matched where possible with a counterpart without autism but with a lifelong disability on parameters of age, sex and IQ level. Parents of the ‘autism’ and ‘non-autism’ groups were then interviewed in detail using four personality assessment instruments. Scores were tabulated for both mothers and fathers in each group and intergroup comparisons were made.

Results: No significant personality profile difference was identifiable between the two parental groups.

Conclusions: Personality traits specific to parents of people with autism are not identifiable in this study thus casting doubt on the validity of personality phenotypes as measurable heritability factors in autism.
Depot antipsychotic prophylaxis in bipolar affective disorder
Authors: Mannion L , Carney PA , Sloan D , O'Toole R
Published: March 2016

Objective: Depot antipsychotic medication is often prescribed as maintenance treatment for patients with bipolar affective disorder. In this study we examined the case notes of 14 patients with bipolar disorder who had been prescribed depot antipsychotics. Our aim was to establish the effectiveness of depot medication in this group.

Method: We calculated the total number of hospital admissions, length of hospital stay, and total number of affective episodes for each patient from the onset of their illness to the time of the study. The frequency of affective episodes and hospital admission were compared during periods on or off depot medication.

Results: Treatment with depot antipsychotics was associated with a significant decrease in the number of hospital admissions, overall affective episodes and manic episodes in particular.

Conclusions: Prophylactic treatment with depot antipsychotics may be useful for certain patients with bipolar disorder, in particular those patients who experience frequent manic episodes. Further proof of the efficacy of depot antipsychotics in the prophylaxis of bipolar affective disorder requires the completion of a double-blind prospective trial.
Survey of symptoms associated with antidepressant discontinuation
Authors: Khan Ashar , Kelly Roisin , Gill Michael
Published: March 2016

Objectives: Literature reports on SSRI associated discontinuation symptoms are variable. As a result, the prevalence of an antidepressant halo effect can not be ruled out. This survey aims to assess the awareness and experience of these symptoms among doctors in Ireland.

Method: Questionnaires were sent to a random sample of 100 GPs, NCHDs and consultants. A questionnaire measured awareness, experience and reported severity, of SSRI discontinuation symptoms as opposed to TCAs, the latter being used as ‘controls’. Data was statistically analysed using SPSS (Windows Version 8.0).

Results: Response to the questionnaire was as follows: 37% of GPs (n = 37), 35% consultants (n = 35) and 18% NCHDs (n = 18). Comparisons were made between the three groups. There was significant variability in the reported recognition and severity of symptoms specific to the SSRI discontinuation syndrome within and between the groups. Overall NCHDs attribute less discontinuation symptoms to SSRIs (p = 0.038) and GPs attribute more to TCAs (p = 0.03).

Conclusions: Doctors tend to generalise discontinuation symptoms to all antidepressants with significant variation in reporting practices. Thus there is a need for randomised control studies to aid the recognition and prevention of the discontinuation syndrome.
Heavy general hospital case notes: a simple case-finding method for psychiatric problems
Authors: Williams Christopher J , House Allan , Holmes John , Stewart Andrew
Published: March 2016

Objectives: To identify whether a simple marker of nonpsychiatric health service contact (weight of general hospital case notes) is helpfulin identifying patients with evidence of psychiatric disorder in a medical and surgical population.

Method: Hospital case note review identifying evidence of past and current psychiatric disorder in patients with heavy, medium and low weight case notes. Responses to letters to general practitioners and review of local psychiatric hospital records were used to validate findings. Setting: A large general teaching hospital in the centre of Leeds, UK. Subjects: Random sample of 240 patients aged 16-65 attending general hospital medical or surgical teams as an inpatient or day patient between April 1, 1991 and March 31, 1992. Patients whose index admission was to the gynaecology or obstetrics unit were excluded. Main outcomes: Non-psychiatric service contact was measured by case note weight and thickness, lifetime admissions and number of consultants seen. Psychiatric disorder was identified using global judgements based on a standardised assessment of the case notes, and also general practitioner statements of current or past psychiatric disorder and record of contact with psychiatric services.

Results: In a detailed examination of 75 cases, 92% of patients with lightweight notes had solely physical factors to account for their presentations, compared to 88% in the middleweight group and 64% in the heavyweight group. Heavier case notes more often contained comments about psychiatric problems affecting the physical presentation (lightweight 8%; middleweight 20%; heavyweight 64%). Patients with heavy case notes more often had a history of contact with psychiatric services as confirmed by the GP or contact at local psychiatric hospitals (lightweight 28% middleweight 24% heavyweight 48%). Amongst the heaviest service users, patients with a psychiatric problem had seen a median of 12.0 lifetime consultants compared to 8.5 in those where a purely physical cause was present.

Conclusions: Patients who have heavy hospital case notes are more likely to have evidence of psychiatric disorder than those with lower levels of hospital contact and this is more likely to have an impact on their physical presentation and clinical course as judged by case note review using structured assessment criteria.
A comparison of suicide in two Irish counties
Authors: Connolly John F , Cullen Anne , Walsh Dermot , McGauran Sheila , Phelan Darra
Published: March 2016

Objectives: To determine to what extent official suicide rates in counties Kildare and Mayo underestimate the rates as clinically determined, and to examine and compare the association between the sociodemographic characteristics of the two Irish counties and trends in the suicide rates.

Method: Populations for the two counties for the years 1988-1994 were calculated. Official suicide mortality data was obtained from the Central Statistics Office. Following examination of the coroners' files for both counties the number of suicides was estimated using clinical criteria.

Results: Neither county showed a significant change in suicide mortality over time from 1988-1994. Suicide was underestimated in official mortality data for each county. There were significant differences in the choice of method of suicide with an excess of drowning in Mayo and of shooting in Kildare. Mayo suicides were more likely to be single and unemployed.

Conclusions: Much local research is needed before implementing suicide prevention programmes due to the many demographic differences and differences in traditions and choice of method of suicide that exist between counties.
A case of co-existent Capgras and deClèrambault's syndrome with a history of morbid jealousy
Authors: Kennedy Noel , Kelly Brendan , Shanley David , Gill Michael
Published: March 2016

A patient presenting with co-existent Capgras and deClerambault's syndromes, with a history of morbid jealousy is described. This combination of syndromes has not previously been described. The relevant literature to this case is reviewed, in relation to the onset of these syndromes, aetiology and treatment. Abnormalities in pathways involving recognition of familiar faces have been implicated in a number of similar cases.
An investigation of one hundred suicides
Authors: Kelleher Michael J , Keohane Brendan , Corcoran Paul , Keeley Helen S , Neilson Stuart
Published: March 2016

Objectives: This study examines the backgrounds of 100 people who died by suicide and whose cases were adjudicated on consecutively over a five-year period, by the two Cork City coroners.

Method: Five main sources of information were used; coroners, relatives, investigating police, general practitioners and hospital records. The cases were examined under the headings of age and gender differences; methods used; social circumstances; illness; treatment prior to death and previous attempts. Certain information may have been missed because peers were not interviewed. There were 72 males and 28 females.

Results: In the 15-44 age group, the male female ratio was 4:1; in those over 45 the ratio was almost equal. Men were more likely to be unmarried even when age differences were taken into account. All the women and all but seven of the men had a psychiatric diagnosis, but women were more than more likely to have received medical treatment in the year before their suicide than men (OR = 6.6). Thirty-seven had made at least one previous suicide attempt.

Conclusions: The study confirms that suicide, particularly for men is becoming more a young person's problem. Psychiatric illness is the single commonest association. Over a third of suicides had made a previous attempt. These findings point to the need to improve recognition of psychological distress and find effective methods to reduce parasuicide.
The utility of neuroSPECT imaging in the investigation of dementia and parkinsonism
Authors: Wyper David , Patterson James
Published: March 2016

Functional neuroimaging is playing an increasing role in psychiatry and has moved from academic isolation into clinical practice. This review examines the basis for the use of Single Photon Emission Computed Tomography, the most widely available functional modality, in the two important areas of dementia and parkinsonism. Its contribution to the diagnosis and management of patients is discussed and its likely impact in clinical trials indicated. As functional imaging moves closer to those most able to utilise its power its impact in these and other areas of psychiatry and neurology will increase further.
Prevalence of psychological problems in Irish school going adolescents
Authors: Lawlor Maria , James Deborah
Published: March 2016

Objectives: To establish the prevalence of psychological problems in older adolescents.

Method: The Youth Self Report was completed by teenagers in a class group. Percentages scoring above clinical threshold were calculated. Gender differences and variances between school type were examined.

Results: Seven hundred and seventy-nine students participated in the study, 373 males and 406 females. Of the girls 23% reported problems in the clinical range on total problem score compared with 19% of boys. Significant gender differences were noted on total problem and internalising scores but not on externalising scores. The levels of psychological problems did not appear to be influenced by school type. Of the total group 6.4% reported thinking of suicide frequently (almost twice as many girls as boys) and this rose to 25% of girls who scored in the clinical range of total problem score and 15% of boys.

Conclusions: Twenty-one per cent of adolescents had problems in the clinical range. Girls reported more problems than boys. It was surprising to find that there was no gender difference in reported levels of externalising problems. The high expression of suicidal and thoughts of self-harm in those with externalising and internalising problems is of concern. This highlights the vulnerability of older adolescents as they tend to fall between the current child and adolescent services. Service provision for this population should be a priority in rural areas and on a national basis.
Scanning the stammering brain
Authors: Breathnach Caoimhghín S
Published: March 2016

Stammering (or stuttering) may be defined as an impairment of continuous utterance. Developmental stammering, regardless of country or language, affects one per cent of adult populations. Exacerbation by the stress of adult conversation or public speaking contrasts sharply with normal flow during singing, acting or conversation with children. Alterations in regional cerebral blood flow suggest that there are underlying differences in sensorimotor function in developmental stammerers whose symptoms commonly appear during the period of intensive language acquisition around the third and fourth year. Emotional tensions may exacerbate the disturbance, but equally psychological growth is adversely affected by the handicap. Abnormal motor control is confirmed by the exaggerated activity in the right hemisphere. The normal sequence of articulatory programming and motor preparation for single word reading is reversed. Absence of activation over the left auditory cortex supports the notion of impaired or diminished auditory feedback in the self-monitoring of speech seen in normal brains. Subcortical abnormalities are a feature of both developmental and acquired stammering.
Suicide, assisted suicide and euthanasia: International perspectives
Authors: Leenaars Antoon , Connolly John , Cantor Chris , EchoHawk Marlene , He Zhao Xiong , Kokorina Natalia , Lester David , Lopatin Andrew A , Rodriguez Mario , Schlebusch Lourens , Takahashi Yoshitomo , Vijayakumar Lakshmi
Published: March 2016

Suicide, assisted suicide and euthanasia are elusive and controversial issues worldwide. To discuss such issues from only one perspective may be limiting. Therefore, this paper was written by authors from various regions, each of whom has been asked to reflect on the issues. The countries/cultures are: Australia, China, Cuba, Ireland, India, Japan, Russia, South Africa, The Netherlands, North America (Turtle Island) and United States. Historically and today, suicide is viewed differently. Assisted suicide and euthanasia are equally seen from multifarious perspectives. Highlighting development in the Netherlands, Australia's Northern Territory and Japan (ie. the famous Yamanouchi Case), the review shows growing re-examination of the right to die. There appear, however, to be no uniform legal and ethical positions. Further debate and discussion globally is needed to avoid myopic perspectives.
Factors affecting GUM clinic attenders decisions and intentions to seek HIV testing
Authors: Salt Jeff , Davidson Kate M , Harvey Jenina
Published: March 2016

Objectives: To evaluate factors that predict HIV testing using the model of health care utilisation as its conceptual framework and to analyse some of the factors that encourage or inhibit seeking an HIV test in this population.

Method: A cross sectional questionnaire study in two Genito-Urinary Medicine (GUM) clinics in central Scotland. A final sample of 195 represented a 91% response rate. Participants were categorised by their HIV testing status (already tested, planning to be tested, no intention to seek testing).

Results: The ‘already tested’ and ‘planning to be tested’ groups were combined as there were no significant differences on reported risk behaviours. Analysis therefore compared two groups those ‘testing’ (n = 66) and ‘not testing’ (n = 129). 67% of those not tested for HIV reported at least one HIV risk factor. Perceived risk was the strongest predictor of HIV testing using our model. Perception of risk and actual risk were not correlated. Those not seeking testing endorsed less benefits of testing and more denial of the need to be tested. Same day testing and testing without an appointment were endorsed as factors to promote testing.

Conclusion: To encourage people who have high risk factors to access HIV testing, programmes should: (1) highlight the benefits of testing which would be lost if people do not test, eg. effective drug treatments (2) increase the range of HIV testing services available (eg. same day testing). Furthermore, studies to determine the main predictors of perceived risk are needed if we are to increase testing in relevant populations.
Suicide rates in Irish counties: 10 years later
Authors: Connolly John F , Lester David
Published: March 2016

Objectives: This exploratory study was designed to explore the social correlates of suicides rates of Irish counties.

Method: Suicide rates were calculated for Irish counties and subdivisions for the period 1988-1994 and correlated with social data for these regions obtained from the 1991 Census.

Results: The suicide rates showed a low level of reliability for the periods 1978-1984 and 1988-1994, and the social correlates of suicide rates changed between the two periods. Whereas age structure was associated with suicide rates in 1978-1984, urbanisation was associated with suicide rates in 1988-1994.

Conclusions: It is important to check the reliability of results of ecological studies of Irish suicide rates. Furthermore, the impact on suicide rates of the changing role of women in Ireland needs to be explored in time-series studies of the Irish suicide rate.
Herbal mania: a diagnostic dilemma?
Authors: Kelly Brendan D , Rawlinson Frank , Ogburn Ben
Published: March 2016

A case of affective psychosis and cognitive impairment is described. The patient had a history of cerebrovascular disease and had been ingesting large quantities of a complex herbal tonic prior to presentation. Diagnostic issues are discussed. Relevant literature on cerebrovascular disease and herbal remedies is reviewed. We propose a stress-diathesis model to account for this patient's illness and we advise caution in the use of complementary therapies in patients with compromised cerebrovascular status. Appropriate practice guidelines are outlined.
The attitudes of Irish trainees to their training and its supervision: a five-year follow up study
Authors: O'Mahony Edmond , Corvin Aiden
Published: March 2016

Objectives: To assess the current attitudes of Irish psychiatric trainees to their training and to determine whether problems identified five years ago have improved.

Method: A postal questionnaire was circulated to all identified psychiatric trainees in the eastern region of Ireland over a six-month period in 2000.

Results: 153 (62%) trainees responded to the study, and 81% described their training as ‘adequate’ or better. Significant demographic changes over the last five years are recorded. Satisfactory induction, regular supervision and access to tutors are all associated with higher overall satisfaction with training. Sixty-seven per cent report receiving an induction course, but just 40% describe this as satisfactory, and only 49% of trainees receive regular supervision. Specific difficulties in training are reported less frequently than in 1995, but 35% of non-EU doctors report racial discrimination in training and only 59% of trainees received a practical demonstration prior to administering electroconvulsive therapy (ECT).

Conclusions: Trainees continue to express high levels of satisfaction with their training. Improvements have been made in a number of key areas, although difficulties remain. For example, regular supervision, which was associated with a positive outlook on training, are unavailable to a majority of trainees.
Outcome of alcoholism in old age
Authors: Johnson Ian
Published: March 2016

Objective:This retrospective study describes the follow-up of a birth cohort of alcohol dependent patients as they enter old age. The aim is to define the global outcome of survivors by combining a measure of current drinking behaviour with ratings for depression and dementia.

Methods:A series of 100 referrals to a regional unit for alcohol misuse in Bristol, England, were followed up at a mean of 13 years after first referral for treatment. Survivors were traced when they were aged between 67 and 77 years. At follow-up interview, subjects were screened for current alcohol problems, depression and dementia.

Results:The mortality rate in the cohort was raised significantly. Almost one third of survivors had depressive symptoms at follow-up and rates of global dementia were higher than expected in an aged-matched sample of the general population. However, the majority of survivors were classified as having an intermediate global outcome with less than 10% having a poor outcome.

Conclusions:The high rates of mortality and psychiatric morbidity observed in this cohort illustrate the importance of detecting alcohol problems in the elderly. Further prospective studies are necessary to validate these findings in a community sample of older people.
An audit of admissions to an acute psychiatric unit
Authors: Kelleher Margaret , O'Brien Sinead
Published: March 2016

Objectives: In an era of cost containment in the health services, it is important to endeavour to manage existing resources in the optimum way. This study examines admissions to an acute psychiatric unit in a general hospital in order to identify factors that characterise these admissions, which in turn may suggest appropriate interventions.

Methods: This was a retrospective casenote review of 105 consecutive admissions. Demographic information and clinical data concerning this admission and service contact in the preceding year was collected. Chi-squared tests were used to compare patients who were admitted during normal working hours with those admitted after 5pm and at weekends. Patients whose length of stay exceeded four weeks were compared with those who had a shorter admission.

Results: Eventually 101 patients were included in the study; of these 46.5% of admissions occurred during normal working hours. Admissions outside this time were more likely to be under 45 years (χ2 = 4.05, df = 1, p <0.05) and to be diagnosed with a depressive illness or schizophrenia/psychosis (χ2 = 19.12, df = 3, p <0.05). These admissions were of shorter duration (χ2 = 4.45, df = 1, p <0.05) and had not been in contact with the community psychiatric nurse (CPN) in the preceding year (χ2 = 4.09, df = 1, p <0.05). Length of stay >4 weeks duration was more likely in single patients (χ2 = 9.68, df = 2, p <0.01), those living outside the more urban areas (χ2 = 4.04, df = 1, p <0.05) and those who had a diagnosis of a depressive illness or schizophrenia/psychosis (χ2 = 13.43, df = 3, p <0.01). Patients with a diagnosis of alcohol or substance abuse were spending significantly shorter periods in hospital.

Conclusions: Further development of day hospitals is necessary to provide alternatives to inpatient treatment and facilitate earlier discharge for patients living throughout the catchment area. Alternative methods of service delivery such as outreach programmes should be considered for subgroups of patients who are unable or unwilling to access traditional services. Introducing outpatient detoxification programmes would have a substantial impact on admission patterns in the unit.
Hyperactivity and conduct disorder: exploring origins
Authors: Mcardle Paul , O'Brien Gregory , Kolvin Israel
Published: March 2016

Objectives: This paper explores the relationship of hyperactivity (HA), conduct disorder (CD) and combined hyperactivity and conduct disorder (HACD) with certain environmental and biological stresses and vulnerabilities.

Method: It is based upon a large epidemiological database from the North of England.

Results: The findings suggest that CD is uncommon and strongly related to environmental stresses. This is true to a lesser extent of HACD. While both CD and HACD were related to family adversity and adverse styles of parental discipline, subtly different patterns of associations are also evident. In particular, CD is linked with poverty, parental violence and contact with child care social agencies. These findings are consistent with the hypothesis that HA contributes to a pattern of confrontation and punishment associated, in some cases, with the emergence of a more complex combination disturbance. However, CD occurs against a background of family conflict and poor child-care.

Conclusions: Most apparent cases of conduct disorder are in fact hybrid conditions including symptoms of HA and CD. True CD should be diagnosed not only by positive symptomatology but also by the absence of hyperactivity symptoms.
Irish Travellers and forensic mental health
Authors: Linehan Sally A , Duffy Dearbhla M , O'Neill Helen , O'Neill Conor , Kennedy Harry G
Published: March 2016

Objectives: To determine whether Irish Travellers are over-represented amongst transfers from prison to psychiatric hospital. If so, to determine whether this represents an excess over the proportion of Irish Travellers committed to prison.

Method: Irish Travellers admitted to the National Forensic Psychiatry service were identified from a case register over three years 1997-1999. New prison committals were sampled and interviewed as part of the routine committal screening to identify ethnicity.

Results: Irish Travellers accounted for 3.4% of forensic psychiatric admissions compared to 0.38% of the adult population. Travellers transferred from prison to psychiatric hospital had more learning disability and less severe mental illness than other groups, while black and other ethnic minorities had a higher proportion of severe mental illness. Travellers accounted for 6% (95% CI 3-11) of 154 male committals and 4% (95% CI 2-12) of 70 female committals. The estimated annualised prison committal rate was 2.8% (95% CI 2.4-3.3) of all adult male Travellers in Ireland and 1% for female Travellers (95% CI 0.8-1.3). Male Travellers had a relative risk of imprisonment compared to the settled community of 17.4 (95% CI 2.3-131.4), the relative risk for female Travellers was 12.9 (95% CI 1.7-96.7). Imprisoned Travellers had greater rates of drugs and alcohol problems than other prisoners (Relative risk 1.46, 95% C11.11-1.90).

Conclusion: There is gross over-representation of Travellers in forensic psychiatric admissions. This reflects the excess of Travellers amongst prison committals.
Concordance of clinical estimation of suicidal intent
Authors: Keeley Helen S , McAuliffe Carmel , Corcoran Paul , Perry Ivan J
Published: March 2016

Objective:The aim of this paper is to assess the level of agreement between clinical estimates of suicidal intent based entirely on information recorded in the Accident and Emergency acute assessment and Beck's Suicide Intent Scale (SIS) scores.

Method:As part of the WHO/EURO Multicentre Study of Parasuicide, cases of deliberate self-harm (DSH) in Cork city hospitals were monitored. Over the period 1995-1997, the information recorded in the Accident and Emergency acute assessment was examined by a psychiatrist and, if possible on the available evidence, clinical estimates were made at three levels of suicidal intent: minimal, moderate and definite. Seventy-nine of these cases had fully completed Beck's SIS. Statistical comparison was made between the results of the SIS and the clinical estimate of suicide intent.

Results:The agreement (Kappa = 0.146, p = 0.046) and concordance (Lin's concordance coefficient = 0.330, p = 0.001) between the two ratings are statistically significant but both are low. The overlap between those identified as high or low intent is low.

Conclusions:These findings indicate low agreement between a clinician's rating of suicide intent based on clinical records and Beck's SIS. This is especially relevant given the increasing reliance on psychometric instruments in assessment in psychiatry. However, further investigation is necessary to clarify which is the more valid method.
A 15-year follow-up of schizophrenia in Ireland
Authors: Finnerty Aine , Keogh Fiona , O'Grady-Walsh Anne , Walsh Dermot
Published: March 2016

Objectives:Psychiatric hospitalisation rates in Ireland have been high. Recent studies indicate that this is not a consequence of raised incidence. This study explored the possibility that poor outcome may have been responsible for this high hospitalisation prevalence.

Method:Through participation in the WHO Study, Determinants of Outcome of Severe Mental Disorders (DOSMeD), we followed up a cohort of 67 first-onset schizophrenic patients over 15 years to determine symptomatic and functional outcomes and to compare these with outcomes of the cohorts recruited to the International Study of Schizophrenia (ISoS).

Results:Thirty-seven (55%) of the original 67 were successfully followed up over 15 years and, of these, 43% were continuously psychotic for most of the period; a similar proportion had recurrent episodes of illness; two-thirds of subjects had moderate to severe symptoms for most of the time; and, in terms of functional outcome, over four-fifths were unemployed at follow-up.

Conclusions:Outcome for the majority of followed-up patients was poor in symptomatic and functional terms. While this outcome was one of the poorest among the DOSMeD groups the question whether functional psychotic illness outcome is inherently poorer in Ireland than elsewhere remains unanswered. The high rate of attrition (45%) from the group during the follow-up period vitiated interpretation of outcome overall. The high number of suicides among the group was noteworthy.
Koro: a case in an Eastern European asylum seeker in Ireland
Authors: Kennedy Noel , McDonough Michael
Published: March 2016

Koro is characterised as a perception that one's genital organs are shrinking and will eventually recede into the abdomen. It was initially described in South East Asia as a culture bound syndrome but this syndrome has recently been recognised in a non-culture bound context A case is described of a depressed Eastern European asylum seeker with koro like symptoms. All symptoms resolved completely with fluoxetine treatment The relevant literature to the case is reviewed, in relation to onset, symptoms and treatment of this rare syndrome. In addition comparison is made with previous reports of the non-culture bound variant.
Pharmacological management of treatment resistant depression: a clinical review
Authors: Kennedy Noel , McDonough Michael
Published: March 2016

Objectives:Treatment resistant depression (TRD), commonly encountered in clinical practice, leads to socioeconomic disability and therapeutic pessimism. This paper reviews evidence for pharmacological approaches used in TRD.

Method:Electronic literature searches were performed using Medline and Psychlit using broad search terms relating to TRD.

Results:Agents that potentiate both serotonin and noradrenaline may allow more patients to achieve full remission. Attention must be paid to dose titration and length of treatment courses in TRD. Augmentation with lithium and switching within antidepressant class or between classes can often improve symptoms but efficacy of other augmentation approaches remains uncertain. Antidepressant combinations and addition of atypical antipsychotics can be useful but combinations of predominantly serotonergic antidepressants should be avoided. Electroconvulsive therapy retains an important role in TRD but pharmacological treatments need to be continued concomitantly.

Conclusions:Good improvement is seen in TRD after vigorous antidepressant treatment but most patients continue to have lower grade symptomatology.
Antipsychotic drugs: atypical advantages and typical disadvantages
Authors: Wright Padraig , O'Flaherty Luke
Published: March 2016

Atypical antipsychotic drugs are recommended for the first line treatment of all patients with schizophrenia. This is because it has been demonstrated that atypical antipsychotic drugs are more effective across a broader range of symptoms of schizophrenia than typical antipsychotic drugs and because they are dramatically less likely to cause the extrapyramidal and endocrine side effects that greatly impair quality of life for patients and reduce their willingness to adhere to maintenance treatment. Atypical antipsychotic drugs are not perfect but they are the most effective and the safest treatment for schizophrenia presently available.

The atypical antipsychotic drugs currently marketed in Ireland for the first line treatment of schizophrenia include amisulpride, olanzapine, quetiapine, risperidone and ziprasidone. These agents differ somewhat in chemical class, indications, daily dose range, need for titration, daily dosing regimen and available formulations (see Table 1). Clozapine is marketed for patients unresponsive to, or intolerant of, other antipsychotic drugs and must thus be regarded as a second line treatment for schizophrenia. Zotepine is not yet available in Ireland while the marketing of sertindole has been suspended following reports of arrhythmias and sudden cardiac deaths.
An audit of psychotropic prescribing practice of general adult psychiatrists in elderly demented patients
Authors: Meaney Anna Maria , Cooney Colm
Published: March 2016

Objectives: In Ireland elderly patients with behavioural and psychological symptoms of dementia (BPSD) are frequently prescribed anti-psychotic and other psychotropic agents. Elderly patients with dementia are more sensitive to adverse effects of medications. Despite this, little is known of the psychotropic prescribing practice of psychiatrists who treat this population. General adult psychiatrists in the Republic of Ireland continue to treat elderly patients with BPSD. The aim of this audit was to identify the prescribing practice of general adult psychiatrists in elderly patients with BPSD. We compare this practice to that of old age psychiatrists in the UK and that recommended by the American Psychiatric Association in 1997.

Methods: We devised a structured anonymous questionnaire, which was forwarded to all general adult psychiatrists in the Republic of Ireland.

Results: Atypical anti-psychotics are frequently prescribed by general adult psychiatrists to manage BPSD in elderly patients. The anti-psychotic agent of first preference chosen to treat psychotic symptoms in dementia is risperidone. Overall, sedative typical anti-psychotics are still the most frequently chosen anti-psychotic agents, chosen to manage behavioural symptoms in dementia. Benzodiazepines and trazadone are the most frequently prescribed other psychotropic agents chosen to manage agitated behaviour. In general the median doses of antipsychotics and other psychotropic medication used are in keeping with both the APA guidelines and practice of old age psychiatrists in the UK. A minority of practitioners (10%) specified at least one dosage regime that was grossly outside recommended ranges.

Conclusions: Overall, prescribing practice in terms of choice of treatment and dosage regime, of general adult psychiatrists in BPSD is in keeping with the best practice guidelines. However, sedating typical anti-psychotics and on occasion extraordinarily high doses of anti-psychotics are still prescribed.
Treatment of early onset bipolar disorder, NOS with low dose Carbamazepine
Authors: McNicholas Fiona , McKenna Laura
Published: March 2016

This report describes the presentation, monitoring and successful treatment of an eight year old girl with bipolar disorder, NOS (not otherwise specified), with low dose carbamazepine. The difficulties of diagnosing and managing bipolar disorder in prepubertal children are discussed.
Self-reported alcohol consumption in the Irish community dwelling elderly
Authors: Greene Elaine , Bruce Irene , Cunningham Conal , Coakley Davis , Lawlor Brian A
Published: March 2016

Objectives: To examine the associations of self-reported alcohol consumption in a community based sample of elderly subjects.

Methods: A total of 518 non-institutionalised community dwelling elderly identified from general practice registers were interviewed in their own homes using the Geriatric Mental State (GMS-AGECAT), the Mini-Mental State Examination and the sociodemographic questionnaire. Physical health was rated on a six-point scale. Self reported alcohol consumption was recorded in units per week. The group was then divided according to the presence or absence of excessive alcohol consumption (ie. consumption of over 14 units per week for females and 21 units per week for males). Results were analysed using multivariate regression analysis with excessive alcohol consumption as the dependent variable.

Results: The mean age of the sample was 73 (range 65-95), 63% (n = 329) were female. Thirty-six per cent of the population were abstinent and 7% reported excessive alcohol consumption. Analysis of the data revealed no association between excessive alcohol consumption and diagnosis, age, cognitive function or poor physical health. Excess consumption was found to be significantly associated with gender (male) and widowed status (p < 0.001, p = 0.013 respectively).

Conclusions: As alcohol misuse is commonly missed in the elderly identifying high risk groups is important for the development of intervention strategies. Our results suggest that elderly widowers may be more at risk than their peers of alcohol misuse.
Obstructive asphyxia: a cause of excess mortality in psychiatric patients
Authors: Corcoran Eleanor , Walsh Dermot
Published: March 2016

The purpose of this study was to determine the number of deaths which were caused by choking in a 10 year period in the Irish psychiatric in-patient population and the factors associated with such deaths.
Porphyria and dementia: a case report
Authors: Gibbons Dympna , Cullen Anne , Garland Malcom
Published: March 2016

The porphyrias are a group of rare hereditary metabolic disorders where there is an excess formation and excretion of porphyrins or their precursors. Type IIA, acute intermittent porphyria (AIP), has an estimated prevalence of one to eight per 100,000 in the general population but is thought to have a higher prevalence in psychiatric patients. AIP can present with a variety of psychiatric symptoms, often misdiagnosed. Associated neuropathological changes including focal cerebral ischaemic lesions have been found. However, to our knowledge, no case of dementia and AIP has been described. We present the case of a 56 year old man with a five-year history of progressive cognitive decline, diagnosed with AIP at an advanced stage of dementia. Whether AIP contributed to the dementia or is a coincidental finding is unknown. However treatment of AIP in this case resulted in some improvement in the patient's cognitive state.
The timing of deliberate self harm behaviour
Authors: Blenkiron Paul
Published: March 2016

Objectives:To critically review the scientific literature relating to the timing of deliberate self harm behaviour and completed suicide.

Method:A literature search of the Medline and CINAHL databases from 1970-2002 was performed, using deliberate self harm, overdose, self poisoning, suicide, parasuicide, and time, timing, day, week, month and season as key words. Relevant secondary references were retrieved and hand searching of important journals was done.

Results:The time of day of non-fatal self harm shows a marked diurnal variation, with an evening peak that is related to non-violent episodes, concomitant alcohol use, and a younger age. It is not conclusively linked to the degree of suicidal intent or particular psychiatric diagnoses. Completed suicides more commonly occur earlier in the day, at the beginning of the week and during springtime, but show no overall increase during many national events and holidays.

Conclusions:Circadian biological mechanisms involving the serotonin-melatonin axis, Cortisol secretion and sleep abnormalities appear to be implicated. Psychosocial explanations for these epidemiological findings include alcohol use, a sense of personal isolation and the ‘broken promise’ effect.
Liaison psychiatry in palliative care
Authors: Payne Ann , Kelleher Michael J , Hayes Yvonne , O'Brien Tony
Published: March 2016

Objectives: Psychiatric disorders are common and frequently undetected and under treated in the palliative care population. The aims of this pilot study were determine to: (1) the incidence of psychiatric co-morbidity; (2) the patient's current insight; (3) future fears regarding symptom control; and finally (4) the degree of satisfaction with their doctors level of communication, at the time of their diagnosis.

Methods: Over a six-month period, 100 consecutive hospice admissions were assessed by AP, within 72 hours of their arrival. This patient group all had advanced malignant disease. A semi-structured questionnaire was used as a guide (see Table 1) to interview. A full history, cognitive and Mental State Examination (MSE) were performed on each patient.

Results: Sixty-four patients were interviewed, 36 were excluded. Sixteen (25%) had a depressive illness, six (9%) had anxiety, 56 (88%) had full or partial insight into their illness. Only eight (12%) were unaware of the nature or implications of their disease. Of those who responded, 19 (30%) felt dissatisfied with how their doctors communicated their diagnosis. A significant proportion, 30 (47%) felt that eventually their symptoms would become out of control.

Conclusions: This was a pilot study by a psychiatrist at the bedside in the hospice setting. We found that by concentrating on psychological symptoms rather than the biological, a diagnosis of depression was possible even in these complex medical patients. However, recognition of treatable anxiety in this population is a challenge. Even though 30 (47%) felt that their most distressing symptoms would become out of control during the course of their illness, we found an incidence of anxiety of only six (9%). This suggests that our interview underestimates the true level of anxiety in these patients, and highlights the need for a low threshold for diagnosis and possibly an objective screening mechanism. Regarding the ‘breaking of bad news’, 19 (31%) of patients were dissatisfied and unhappy with this experience and there is clearly room for improvement in communicating a diagnosis of malignancy.
A one-year audit of specialist psycho-oncology services in an Irish tertiary referral centre
Authors: Hallahan Brian , Garland Malcolm
Published: March 2016

Objectives: Psychological services to patients with cancer are very limited in Ireland. A dedicated psycho-oncology service was established at our Institution 18 months ago. The aim of this study was to examine referral rates, psychiatric diagnoses and treatment interventions in this patient group.

Methods: The clinical and psychiatric characteristics of consecutive patients (n = 63) referred to a recently established specialist psycho-oncology service in an Irish university teaching hospital over a one-year period were examined prospectively. International diagnostic criteria were applied. Forms of treatment instituted and clinical response to same were also audited.

Results: Over half (54%) of patients presented with affective disorder spectrum illnesses. The remaining referrals represented a diverse group of psychiatric diagnoses, but included a large proportion of patients with delirium. Approximately 20% of patients did not meet criteria for a psychiatric diagnosis. There was an over-representation of breast cancer and lymphoma. Thirty-eight per cent of patients were on prescribed corticosteroids at the time of referral. Eighty-two per cent of patients required some form of psychiatric intervention, and 86% of these benefited clinically from our intervention.

Conclusions: The data suggest that even in oncology services with good existing support networks, such as this one, the role of an additional input from liaison psychiatry is considerable.
The case of Robert Walser (1878-1956)
Authors: Lyons Viktoria , Fitzgerald Michael
Published: March 2016

Robert Walser (1878-1956), one of the great literary geniuses of 20th century German literature, was also one of the most mysterious writers of his time. Born in Switzerland in 1878 he was diagnosed with schizophrenia at the age of 50 and spent the remaining two and a half decades of his life in Swiss psychiatric hospitals until his death in 1956. His literary legacy consists of four novels, numerous pieces of short prose (essays and stories) as well as 526 pages of pencil notes written in minuscule script, the famous ‘micro-gramms’.

Although highly unsuccessful during his lifetime and leading the life of an artist on the margins of society, his writings have been linked to Kleist, Kafka, Joyce and Beckett. The silencing of Walser's unique voice by mental illness and his disappearance behind the walls of psychiatric hospitals has been considered a tragedy and over the years doubts were raised about the true nature of his illness.