COVID-19 or ‘Coronavirus’ has become a global pandemic since its initial report in Wuhan, China, on November 17, 2020. It is highly infectious and poses significant health risks for those in vulnerable populations. This article aims to provide perspective into an Irish experience, through the eyes of a practicing psychiatric nurse, who has recently graduated medical school and intends to work as an intern doctor.

Objective: This study is designed to evaluate a hospital based integrated service for the comprehensive delivery of care and treatment to patients with schizophrenia, on epidemeological, cost effectiveness, and quality of life parameters. Methods: All patients with an ICD9 diagnosis of schizophrenia who received services from the St. Lomans Catchment area during a 2 year period were evaluated for service utilization during a subsequent 2 year period. Data was collected on basic demographics for the epidemiological aspects of the study, and for all aspects of services utilized, eg. day hospital attendance, inpatient bed useage, time spent with psychiatrist, community nurse visit or clinic visit. Costs for all services were calculated using disaggregate cost data. Quality of life of the patients was assessed through the Lehman quality of life questionnaire administered to every third identified patient. Results: 572 schizophrenic patients were identified from the case register and case records search. An analysis of the data indicated no difference in age of first contact with services on rural/urban or male/female comparisons contrasting with previously reported findings. Males tend to utilize proportionately more services in both rural and urban settings. Inpatient hospitalizations contributed the most to per patient costs and a small group of patients, comprising less than 5% of the total population, consumed 10% of the total costs consumed by all diagnostic groups and 30% of the costs of all schizophrenics. Non-hospitalized patients experienced the highest quality of life ratings. Conclusions: Hospital based community services to schizophrenics can be run cost-effectively. There remains a small subgroup of schizophrenic patients who are hard to place or treat in the community and they consume a disporportionate amount of the hospital's costs. Services that attempt to establish patients in the community can do so cost effectively provided there are hospital inpatient beds available as a back up. The benefits of this type of comprehensive service delivery to the schizophrenic population served are demonstrated.

Objectives: The prescription of stimulant medication to children with attention deficit hyperactivity disorder remains topical. Few reports target children's views about taking long-term medication. The aim was to assess child and parent views of stimulant medication. To compare attitudes to medication between two groups of children, those with attention deficit hyperactivity disorder taking stimulant medication and those with epilepsy taking anti-epileptic medication.

Method: Forty children (n = 40) with attention deficit hyperactivity disorder on stimulant medication, and 40 children (n = 40) with epilepsy on anti-epileptic medication formed the study population. A semi-structured interview was carried out with each child and parent. Each parent completed the Dosage and Side-effects Questionnaire and the Attitude to Medication Questionnaire. Each child completed the Attitude to Medication Questionnaire.

Results: Sixty per cent of children (n = 24) with attention deficit hyperactivity disorder and 62.5% (n = 25) of those with epilepsy knew the name and purpose of their medication. Forty per cent (n = 16) of children in the stimulant group and 32.5% (n = 13) in the anti-epileptic group reported themselves as being non-compliant with medication. In both groups children reported positive aspects to taking medication. More children with epilepsy reported negative aspects. Only 32.5% (n = 13) of children with attention deficit hyperactivity disorder said that they would tell a friend about their medication, while 55% (n = 22) of the children with epilepsy indicated that they would do so. In both groups parents were better informed than their children were about the purpose of the medication. Parents of children with attention deficit hyperactivity disorder tended to be more positive about medication than their children and than the parents in the comparison group.

Conclusions: The majority of children and their parents express positive views about the stimulant medication. Children's views about medication compliance and side-effects should be sought, as they may differ significantly from those of their parents. Where parents have noticed positive changes, but children have not, this information can be used therapeutically to help children feel more in control of their behaviour.

Attention deficit hyperactivity disorder (ADHD) is characterised by inattention, hyperactivity and impulsivity with onset in children before the age of seven years. ADHD is the most common disorder presenting to child guidance clinics and has been shown to be a well-validated diagnosis. Current estimates of prevalence range from 1%5%. The concept of adult ADHD as a clinical entity is an emerging but controversial area in psychiatry. While childhood ADHD is accepted as a reliable and valid diagnosis, the validity of adult ADHD as a disorder is unclear. This paper reviews the likely presenting features of adult ADHD and common comorbid disorders. Guidelines for assessment and management are discussed and the evidence for validity of the diagnosis is critically examined.

As research into psychotic illness evolves along established lines, insights are emerging that deviate from those lines and challenge more fundamentally our understanding. On the background of a new generation of studies on first-episode psychosis, investigations across the gene–environment interface and the intersection with ‘normal’ human mentation heighten these concerns. Using findings from the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS) as an exemplar, we here review the complexity of these challenges from the perspective of this real-world setting. They range from trans-diagnostic epidemiology and clinical characterisation, through molecular genetics, social milieu, developmental pathobiology and functional outcome across arbitrary diagnostic boundaries, to the evidence base for early intervention and more radical conceptualisations and structures for provision of mental health care.

Objectives: To establish the prevalence of psychological problems in early school leavers, who attend training schemes.

Method: The Youth self report inventory was completed by teenagers as part of a group setting. Percentages of those scoring above clinical threshold were calculated and gender differences examined.

Results: 78 teenagers participated in the study, 40 males and 38 females. 24% were classified as being in the clinical range of total problem score. Girls reported more total, internalising and externalising problems than boys. 13% of girls frequently thought of suicide and 7% had frequent thoughts of self harm, this contrasts with none of the boys admitting suicidal ideation and 2.5% reporting thoughts of self harm.

Conclusions: 24% of this group experienced problems which placed them within the clinical range. Girls experienced greater problems than boys and appear to be at greater risk of self harm. This group appear to be representative of those who attend training programmes, however it is not possible to determine whether they are representative of all early school leavers. This highlights the vulnerability of older adolescents, and in particular those who leave school early. More detailed examination of issues facing this group are needed and should be a priority along with greater service provision from the educational and health sectors.

Wilson's Disease (Hepatolenticular degeneration) is an uncommon disorder of copper metabolism, characterised by excessive copper deposition in the liver, brain and eyes. Psychiatric symptoms were prominent in eight of the twelve patients originally described by Wilson some 88 years ago. Since then a wide range of psychiatric presentations have been documented including behavioural disturbances, affective psychoses, schizophrenia-like psychoses, intellectual deterioration and dementia. Here we describe a patient who presented with a psychiatric disturbance, was treated with neuroleptic medication and subsequently developed Neuroleptic Malignant Syndrome (NMS).

The search for biomarkers for autism spectrum disorder (henceforth autism) has received a lot of attention due to their potential clinical relevance. The clinical and aetiological heterogeneity of autism suggests the presence of subgroups. The lack of identification of a valid diagnostic biomarker for autism, and the inconsistencies seen in studies assessing differences between autism and typically developing control groups, may be partially explained by the vast heterogeneity observed in autism. The focus now is to better understand the clinical and biological heterogeneity and identify stratification biomarkers, which are measures that describe subgroups of individuals with shared biology. Using stratification approaches to assess treatment within pre-defined subgroups could clarify who may benefit from different treatments and therapies, and ultimately lead to more effective individualised treatment plans.

Objectives: The changing family and social patterns in modern society are likely to influence the availability of informal support for older people. The aims of this study were to determine the support network distribution of a community dwelling elderly population in Dublin, and of those with mental disorders (dementia, depression and anxiety).

Methods: Interviews with 1,001 community dwelling older people using GMS-AGECAT. In addition, a support network assessment instrument was administered, which identifies five different support network types. The local integrated and wider community focused networks are characterised by extensive community involvement, family dependent networks by close family support, and the local self contained and private restricted networks by low levels of family and community involvement.

Results: Of the elderly population, 83% had support networks characterised by close community and/or family involvement. Subjects with cognitive impairment had lower levels of informal support from the community, as indicated by a lower proportion of local integrated (44% v 63%) and a higher proportion of private restricted (6% v 12%) networks. Late life depression was also associated with decreased levels of community integration.

Conclusions: The elderly in Dublin appear to have high levels of informal support. The extensive support may be a factor in the lower rates of depression found in Dublin than in London and New York. While the overall level of informal support available to older people with mental disorders in the community remains high, a proportion have low levels of family and community involvement and consequently their mental health problems may go unrecognised.

Objective: Media portrayals of mental illness and psychiatry have a considerable impact on public perceptions of mental health issues. This paper aims to focus on portrayals of psychiatry and psychiatrists in four contemporary Irish feature films in order to make wider points on this theme.

Methods: Contemporary Irish feature-films that made substantial reference to psychiatry, psychiatrists or mental health in Ireland were identified though electronic searches and consultation with the Film Institute of Ireland. Selected films were viewed. Electronic searches were performed in the medical and film literatures, with broad search terms related to film, psychiatry, psychiatrists or mental health in Ireland. Additional books and papers were identified by tracking back through references and consulting with colleagues.

Results: The portrayal of psychiatrists in film is closely related to the development of both twentieth century psychiatry and twentieth century cinema. In common with recent European films, certain recent Irish films have tended to show psychiatrists as sympathetic, humane individuals (with some notable exceptions). While there have been a number of portrayals of dissocial personally disorder and various states of chronic alienation in recent Irish film, there have been fewer portrayals of psychosis or learning disability. Recent Irish films emphasise the role of alcohol in causing and perpetuating psychological distress. They generally provide unflinching portrayals of the effects of psychological distress and alienation, suicide and substance abuse at individual, family and community levels; nonetheless, there is still a regrettable tendency for films to associate mental illness with dissocial behaviour.

Conclusions: The portrayal of mental health issues in film presents both challenges and opportunities to film-makers, mental health service-users and general audiences alike. It is to be hoped that the recent trend towards realistic explorations of mental health issues in many European films continues into the future. Increased research in this area would help clarify the role of cinema in shaping public understandings of mental illness, and may also help identify additional ways of addressing stigma in the future.

Objective: The original DWR test, which measured delayed free recall, was reported to have high predictiveaccuracy in discriminating Alzheimer's disease (AD) patients from control subjects (overall accuracy of 95%).Comparison of differential performance in free recall and recognition of the same material may be of clinical interest. In the present study a delayed recognition component was added to the DWR test and the utility of both measures in discriminating AD patients from control subjects was evaluated.

Procedure: This extended version of the DWR test was administered to 66 patients meeting NINCDS/ADRDA criteria for probable AD and 42 control subjects.

Results: In a comparison between 42 of these patients (MMSE range 18–29), and 42 age matched healthy controls, both the delayed free recall and recognition measures were highly accurate in distinguishing patients from controls. The free recall measure achieved 98% sensitivity, specificity and overall accuracy, while the recognition measure yielded 98% sensitivity, 95% specificity, and 96% overall accuracy. The recognition performance of all 66 patients, ranging in severity from very mild to severe (MMSE range 11–29), was also evaluated to determine its relationship, if any, to measures of global cognitive impairment. While therecognition measure correlated poorly with MMSE and CAMCOG there was a modest but significant correlation with the CAMCOG memory subscale.

Conclusions: In this study of highly selected AD patients both the free recall and recognition measures were sensitive and specific indicators of AD compared to control subjects. Recognition performance appears to be more closely related to degree of amnesia than to degree of global cognitive impairment.

Objectives: This small exploratory study aims to investigate the characteristics of those convicted of rape or serious sexual assault against an elderly person (aged 65 years or over) who were referred to the Irish Forensic Psychiatry Service for assessment.

Method: A retrospective examination of the case histories of such individuals both at the Central Mental Hospital, Dundrum, Dublin and at Arbour Hill Prison, Dublin between 1989 and 1995.

Results: Ten such cases were found. The most frequent diagnoses were those of schizophrenia and alcohol dependence syndrome. A dual diagnosis of both schizophrenia and alcohol dependence was common. A high percentage of the schizophrenia cases had been previously charged with sexual offences and most were non-compliant with prescribed psychotropic medication at the time of the offence.

Conclusions: A very small number of people with mental illness may be at increased risk of committing a sexual offence against an elderly person. Further study of such offenders is merited.