Objective: This study aims to determine if there is a relationship between antenatal depression and maternal depression in the following three to four years. Secondly, to establish if there is a relationship between maternal depression and behavioural problems with the pre-school child. Thirdly, to investigate if social parameters are correlated with maternal health and childhood behaviour.

Method: In a longitudinal study, a sample of women were screened for depression at the antenatal stage and followed up four years later. Mothers were screened for depressive illness on both occasions. Children's behaviour was assessed at four years. Social parameters were also measured at the pre-school stage.

Result: Depression at the antenatal stage was not found to be significantly related to depression at the pre-school stage. The existence of a behaviour problem was not significantly related to the depressive state of the mother antenatally, however a currently depressed mother is approximately six times more likely to have a child with behaviour problems than a mother who is not depressed. Social factors were also assessed and found to correlate with maternal depression.

Conclusion: In managing a child with behavioural problems the child psychiatrist should consider the mental state of the mother. The social world of the individual would appear to be important and should not be ignored when treating either a child with behavioural problems or an adult with depression.

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.

Objectives: To investigate the nature and pattern of teenage admissions (13-18yrs) to the 14 adult psychiatric units in Northern Ireland (NI) between 1989 and 1995.

Method: An analysis of routine hospital data, a review of case-notes at one hospital and in-depth interviews with young people previously admitted to adult inpatient care.

Results: Sixteen per cent of all under 25s admitted during the six-year period (443/2823) were under 18. There was an increasing trend over time in admissions and re-admissions to hospital. More than half of the teenagers were female and the most common diagnoses included emotional/conduct disorders, ‘stress’ and neurotic illnesses. Self-harm, substance abuse and exposure to violent/abusive environments or behaviour were the most commonly recorded factors preceding admission. All but one of the small number of people interviewed had attempted suicide prior to admission to hospital.

Conclusions: The increase in the use of adult inpatient care by young teenagers is of considerable concern but may be unavoidable in the absence of suitable alternatives especially for adolescents at risk of self-harm or suicide. Further research is required to determine the most appropriat e and effective service response for this vulnerable group . The findings have important implications for the future development of adolescent mental health services.

Objective: Post-traumatic stress disorder (PTSD) is one of the most prevalent psychological disorders. Methods to alleviate its symptoms range from ‘talking therapies’ to pharmaceutical interventions. Our objective was to carry out a systematic review of the effectiveness of sertraline, an SSRI, as a treatment for PTSD.

Method: Databases were searched to identify relevant research on sertraline as a treatment for PTSD.

Results: Five randomised control trials were identified, along with seven open trials and case series studies.

Conclusions: The review and meta-analysis supported the use of sertraline for PTSD though further research on sub-group differences (eg. gender) is required.

Precision medicine is a new approach that considers differences in genes, environment, and lifestyle in an attempt to tailor treatments for individual patients. Psychiatry, as a discipline, has historically relied on clinical judgement and phenomenology-based diagnostic guidelines and has yet to take full advantage. This editorial provides an insight into the expanding role of precision medicine in psychiatry, both in research and clinical practice. It discusses the application of genetics and subgroup stratification in increasing response rates to therapeutic interventions, mainly focusing on major depressive disorder and schizophrenia. It presents an overview of machine learning techniques and how they are being integrated with traditional research methods within the field. In the context of these developments, while emphasizing the considerable potential for moving toward precision psychiatry, we also acknowledge the inherent challenges.

Objective: Two day hospitals were established in North Dublin in 1989 to play a key role in the first old age psychiatry service in the Republic of Ireland. The purpose of this study was to identify the characteristics and needs of day hospital attenders, to carry out a preliminary evaluation of the role of the day hospitals in meeting these needs, and make recommendations for future developments. Method: All 237 regular attenders between March 1989 and 1992 were included. Demographic, social, medical and psychiatric data including CAGE questionnaire, Folstein mini-mental state, and Clifton Assessment Procedures for the Elderly survey version, were recorded at initial assessment. Data on duration and outcome of attendance, use of inpatient, general hospital and community care services were collected from a retrospective study of records and subjected to statistical analysis. Results: The average age was 78 years (SD 6yrs); 139 (59%) patients had organic and 98 (41%) had functional psychiatric disorders; 198 (84%) patients had a medical problem. In the functional group, 24 (25%) required acute admission; 70 (71%) patients were managed in the community. Twenty eight (29%) patients required residential care or had died on average 8 months after initial contact. In the group with dementia 104 (75%) had CAPE scores C/D/E at initial assessment, indicating high dependency. Eighty eight (63%) patients were in residential care or dead on average 8 months later. Conclusions: Day hospital treatment enabled elderly patients with functional psychiatric illness to be treated in the community with low usage of beds. It provided only short/medium term care for patients with dementia, who had little support from statutory services. A comprehensive network of services is necessary to support highly dependent patients in the community.

The literature on alprazolam is reviewed. It is concluded that it is an effective anxiolytic but that it is not an antidepressant. When used in sufficiently high dosage it can block panic attacks, but it is not the only antipanic agent available. It may be used as an alternative to other benzodiazepines in the acute detoxification of alcoholics. It should be avoided where there is strong individual likelihood of abuse. Chronic usage (more than a few weeks) demands a very slow tapering of dosage. Carbamazepine may ameliorate withdrawal symptoms. The use of alprazolam in other conditions remains unproven.

Objectives: To determine the extent to which general practitioners are currently active in the screening, assessment, diagnosis and management of eating disorders. To identify current deficits in service delivery for eating disordered patients, as identified by general practitioners.

Method: A postal questionnaire was circulated to 360 general practitioners within the greater Dublin area and North Eastern Health Service Executive.

Results: Response rate was 25%. Respondents had lower case-loads of eating disordered patients than would be expected given the epidemiology of anorexia and bulimia nervosa. Most do not routinely screen for eating disorders, even in at-risk populations and are unaware of the current evidence-based data for guidance. GPs do not feel confident at managing eating disorders within the primary care setting and see their chief role as that of referral to psychiatric services. Treatment outcomes are typically poor. Concern was expressed at the lack of access to specialist treatment in the public sector. Specific deficits in service provision were highlighted including delays in assessment, lack of services appropriate to the adolescent population, poor service transition, and poor availability of psychotherapy at primary care level.

Conclusions: Eating disorders are currently underdiagnosed in the primary care setting. Use of simple screening tools might aid detection of pathological eating patterns, particularly in at-risk groups. General practitioners feel under-equipped to manage these complex disorders, given that the resources required to provide high quality care are not widely available. Better integration of primary and secondary services, coupled with training for GPs in the area of screening, assessment and diagnosis, may lead to earlier intervention and improved outcomes.

Objectives: To establish suicide rates of psychiatric inpatients in Ireland and the characteristics, demographic, social and medical, of the patients involved.

Method: Clinical, post mortem and inquest data on all such deaths from 1983-1992 were examined. Suicide rates were calculated using ‘person year method’.

Results: The suicide rate for short stay inpatients (stay less than one year) was 319/100,000, and 118/100,000 for long stay patients. The average duration of illness at time of suicide was 10 years. A fourfold increase in suicide rate of inpatients over the century was associated with a similar increase in the suicide rate in the general population. Thirty five per cent of suicides were aged 25-34 years. The risk of suicide was higher the shorter the time interval after admission. Three quarters of suicide deaths in registered inpatients occurred away from hospital grounds.

Conclusions: Social factors which contribute to an increase in the suicide rate in the general population are relevant to the increase in hospital inpatient suicides. More effective and comprehensive services to meet the needs of those with severe mental illness, particularly young adults, are essential. The results emphasise the importance of managing inpatients in a safe, secure environment. The person year method is appropriate for monitoring changes in suicide rates.

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.

Hepatic encephalopathy is a neuropsychiatric disorder usually associated with severe hepatic insufficiency. It may however be divided into clinical and subclinical groupings. Psychometric testing, serial EEG's, EEG spectral analysis and event related potentials are all presently being used to quantify and differentiate between the various stages of hepatic encephalopathy. We review the use of psychometrics in hepatic encephalopathy and discuss evidence that these findings are comparable with the more objective data of electrophysiological studies. An adequate, simple and inexpensive assessment may be carried out using a battery of psychometric tests which include number connection tests and five pointed star construction.

To date, Ireland has been a leading light in the provision of youth mental health services. However, cognisant of the efforts of governmental and non-governmental agencies working in youth mental health, there is much to be done. Barriers into care as well as discontinuity of care across the spectrum of services remain key challenges. This editorial provides guidance for the next stage of development in youth mental care and support that will require significant national engagement and resource investment.

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.

Objectives: Initial examination of data held by the Mental Health Commission indicated a number of patients having repeated involuntary readmissions (defined as patients having three or more involuntary episodes in a calendar year). The Commission sought more empirical analysis of the data relating to these patients, to determine if there were any trends or commonality regarding their demographic characteristics, length of episode, and diagnoses.

Methods: From 1 November 2006 the Mental Health Commission has been notified of all involuntary admissions in Ireland under the Mental Health Act (2001). From this national database information on patients who have had three or more involuntary admissions per year was analysed.

Results: In the period studied there has been an overall reduction in the number of voluntary and involuntary admissions to Irish psychiatric hospitals and units. However, the use of involuntary admission remains constant at around 10% of all admissions. Seven percent (n=569) of involuntary admission orders in this four year period relate to two percent (n=121) of all involuntary patients. Patients who have experienced repeated involuntary admissions are predominantly male (59%), often have a diagnosis of schizophrenia, or schizotypal and delusional disorders (57%), or mania (20%), are in the age band 22-64 (80%) and more often live in rural counties.

Conclusions: Potential appears to exist to significantly reduce the number of involuntary admissions by focusing on the care given to patients who are repeatedly re-admitted. More analysis is needed of voluntary and involuntary re-admissions if inpatient facilities are to be effectively configured.

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.