Objective: We sought to establish the views of general practitioners about detecting and managing patients with a first episode of schizophrenia in Ireland.

Method: Twenty per cent of GPs were invited to participate in a cross-sectional postal survey.

Results: Sixty-two per cent (n = 261) participated. Almost all (99.2%) see at least one case of suspected first episode schizophrenia annually. The most commonly (80.7%) encountered symptom is ‘bizarre behaviour’. Many (47.7%) rarely or never prescribe antipsychotics to patients whom they suspect have a first episode of schizophrenia. However, 80.6% of GPs reported that they ‘always’ refer this group of patients to psychiatric services. Over half (57.8%) advised patients with schizophrenia to continue medication for less than a year. A large number of respondents reported that it is difficult to obtain a rapid psychiatric assessment.

Conclusions: GPs want more information about identifying early psychosis, a closer liaison with psychiatric services and a rapid intervention service.

Objectives: Dual diagnosis refers to co-occurring substance use and psychiatric disorders. The principal aims of this investigation were two-fold: 1) to identify aspects of patients' drug use and prior treatment histories associated with their receiving a dual diagnosis upon admission to the Donwood Institute, a residential drug treatment facility located in Toronto, Canada; 2) to track temporal trends in the rates of diagnosed comorbidities over a five-year period at this same institution.

Methods: We conducted an analysis of the intake assessment forms and hospital records of 159 patients who had been admitted to a drug treatment facility during the month of September for each of the years between 1998 and 2002 inclusive. Comparisons were made between patients who had received a psychiatric diagnosis on admission and patients who had received no such diagnosis. We then employed logistic regression analyses to explore the relationship of the variable psychiatric diagnosis on admission to other patient variables.

Results: Among the patients studied in our sample, those receiving psychotherapy or taking prescription psychotropic medication at the time of their admission as well as patients whose primary problem substance was cannabis or who had been previously admitted to the treatment facility were significantly more likely to have received a psychiatric diagnosis on admission, in spite of our finding that several patients receiving psychotherapy or taking at least one psychotropic medication did not receive a psychiatric diagnosis on admission.

Conclusions: Whilst our data indicate that psychiatric comorbidity is common among individuals in treatment for substance use disorders at the Donwood Institute, it is possible that some individuals with psychiatric illness in our sample were not diagnosed as such when presenting for treatment of their substance use difficulties. Moreover, temporal tracking of rates of dual diagnoses did not reveal a consistent increase during the period studied.

Objectives: There is a paucity of data concerning the prevalence of alcohol use disorders and binge drinking in the general hospital adult population in Ireland. We therefore examined the point-prevalence of alcohol use disorders and of binge drinking in the adult inpatient population of the acute wards of an Irish university teaching hospital. The secondary aim was to examine gender, age, and patient group (medical/surgical) as risk factors.

Method: We administered the Alcohol Use Disorders Identification Test (AUDIT) to all consenting patients (n = 126) on the acute adult medical and surgical wards over one day.

Results: 76% of all inpatients on the acute medical and surgical wards were interviewed (n = 126) using the AUDIT.

Of the subjects 28% screened positive for an alcohol use disorder. Of these 91% were identified as binge drinkers.

A further 8% of the subjects screened positive for binge drinking but were not identified as having an alcohol use disorder.

Overall, 36% of the subjects screened positive for either an alcohol use disorder and/or for binge drinking using the AUDIT.

Male gender and under 65s were risk factors for both alcohol use disorders and binge drinking.

Conclusions: The high point-prevalences of alcohol use disorders and binge drinking in hospital inpatients in particular are a cause for concern as they may have illness complicated by or secondary to undiagnosed alcohol excess. As this population is an easily accessible group for screening, and clinical and economic evidence supports intervention, we recommend screening all acute hospital admissions for alcohol use disorders and binge drinking, followed by appropriate management.

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.

The lifetime prevalence of bipolar affective disorder is between 1 % and 2%. This educational review paper focuses on two areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists: (a) advances in the genetics of bipolar affective disorder; and (b) mood-stabilising medication in bipolar affective disorder.

Suicidal behaviour is a major public health problem worldwide, both with regard to mortality and treatment of clients who have deliberately harmed themselves. It is a multifaceted problem resulting from complex interactions between social, biological and psychological factors. There is insufficient evidence on which to make firm recommendations about the most effective forms of treatment This is remarkable considering the extent of the problem worldwide, and the importance of dealing with it appropriately in order to prevent further suicides.

Objectives: An increasing number of research studies support the benefits of providing music therapy in addition to standard treatment for people who have mental disorders. The objective of this paper was to review and summarise recent research findings in relation to this work.

Method: A review of music therapy studies published since 1994 was undertaken. Criteria for including papers were that they a) were published in English in an indexed, peer-reviewed journal, and b) were conducted as a randomised controlled trial (RCT) or a controlled trial (CT), or c) provided a meta-analysis of existing studies. The large number of papers pertaining to music therapy for older adults who have mental disorders, including Alzheimer's disease and other types of dementia was not included.

Results: The findings support a role for music therapy as a structured interaction that patients are able to use to participate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music therapy is demonstrated to be a beneficial intervention for people who have enduring mental illness. Music therapy invites and encourages participation from people of lower functioning levels and employs a non-verbal medium with which people have prior positive associations and in most cases have lifelong experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.

Conclusions: Music therapy is beneficial for patients receiving care for mental disorders and establishing this therapy within mental health service provision should be considered.

Background: Clozapine is the prototype atypical antipsychotic used for treatment-resistant schizophrenia, but its use has been limited by the well-established association with agranulocytosis. An increased risk of other serious adverse events such as myocarditis and thromboembolism has also been suggested to be associated with clozapine therapy.

Aims: We describe an Irish case of multiple pulmonary emboli detected by CT pulmonary angiogram thought to be secondary to clozapine therapy.

Conclusion: Although clozapine is a very efficacious antipsychotic its many side-effects limit its use. Pulmonary embolism must be remembered as a potential rare side-effect in clozapine therapy. Underlying mechanisms are still unclear although several have been proposed.