Objectives: Suicide is now the commonest cause of death among young Irish males. The literature identifies a wide range of contributory risk factors in suicide. However, a number of realities have frustrated clinicians' efforts in the area, including the reluctance of young males to engage in mental health services. In this study, we sought to explore the problems experienced by young men in a rural setting and their attitudes towards seeking help.

Methods: Focus groups were employed to generate themes for a qualitative and quantitative questionnaire which was administered to a community sample of 71 young men (22.4% of the total number of males aged 16-30 years in the area) and 79 key informants. The questionnaires contained demographic items and examined available social outlets, types and extent of difficulties experienced by young men and perceptions of and access to potential sources of support.

Results: Both young men and key informants reported that peer pressure and alcohol misuse are areas of most difficulty, that friends and family are the preferred sources of support and that young men view much existing professional help as unacceptable.

Conclusions: This study provides a basis for the next stage in the research cycle and also supports the viability of building a partnership between the health services and the local community in developing future suicide prevention strategies for young men.

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

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

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

Conclusions: A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.

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

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

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

Conclusions: Psychopathology and personality status contribute to social dysfunction in patients presenting as emergencies but persistent social dysfunction is more likely to reflect personality pathology than other forms of mental disorder.

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

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

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

Conclusions: Suicide is more likely than other causes of death to lead to psychiatric morbidity in elderly parents. The needs of elderly survivors should be considered in formulating national strategies for suicide prevention. Further studies are needed on risk factors for complicated bereavement in the elderly.

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.

Objectives: To evaluate the effect of a risk assessment tutorial on the adequacy of case note documentation in a general adult psychiatry setting.

Methods: A comparison of case note documentation of risk factors for violence prior to and subsequent to a risk assessment tutorial.

Results: Prior to the tutorial there were very low rates of documentation of risk of violence. Subsequent to the tutorial, statistically significant improvements in documentation occurred in approximately one third of the items being assessed. Significant improvements occurred in the following; recording a collateral history (from 18%-36%) and previous history of deliberate self harm (from 24%-50%), noting emotions related to violence in the mental state examination (from 2%-24%) and documenting a risk management plan (from 2%-28%). However, levels of documentation remained overall sub-optimal.

Conclusions: Some improvement in case note documentation can result from providing tutorials in risk assessment. However, the ideal format for teaching risk assessment needs to ascertained.

Selective serotonin reuptake inhibitor induced mania has been described in adults, and more recently in adolescents. To the authors' knowledge a case in pre-adolescents has not yet been published in the literature. The authors would like to report two cases of SSRI-induced mania. Both cases were pre-adolescent girls, A and B, who had a DSM-IV diagnosis of panic disorder, and were treated with paroxetine.

Luis Simarro, Santiago Ramón y Cajal and Joaquín Sorolla were friends who cultivated art and science in an unhappy Spain. Simarro was the country's leading psychiatrist at the turn of the 20th century, Ramón y Cajal, or simply Cajal as he came to be known in the wider world won the Nobel Prize for his work on the nervous system, and Sorolla is remembered as ‘the Velázquez of light’. All three felt a deep love of Spain and strove to bring freedom, science and the light of truth to their countrymen, each in his own unique way.