Objectives: Over the counter (OTC) medication abuse is an increasing public health concern. We studied the clinical profiles, treatment and prevalence of patients admitted with OTC opiate abuse.

Method: Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded.

Results: Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.0 mg per person. Some 75% percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have co-morbid psychiatric (n=19, 95%), physical (n=17,85%) and polysubstance (n=13,65%) illness.

Conclusions: OTC opiate abuse is a significant problem which is largely covert in nature with serious co-morbidity and frequent complications including withdrawal symptoms which require treatment. Results of this study suggest that further research is warranted in this area.

Objective: To study the relationship between epilepsy and aggression in a population of severely mentally handicapped people. Methods: Comparing epilepsy and aggression variables in people with epilepsy without aggression, people with aggression without epilepsy, and people with both. The epilepsy variables were: seizure frequency, classification, anticonvulsant drugs, therapeutic drug monitoring, and neuroleptic drugs. Aggression variables were: frequency, direction, type, and neuroleptic drugs. Results: Prevalence of aggressive behaviour was similar in people with and without epilepsy (36%). Partial seizures were less prevalent in people with epilepsy and aggression. People with epilepsy were more likely to manifest unprovoked aggression directed against property. Conclusion: Some episodes of aggressive behaviour in people with epilepsy may be ictal in origin.

Objectives: To evaluate the clinical utility and validity of the Health of the Nation Outcome Scales (HoNOS) in an Irish catchment area psychiatric service.

Method: One hundred consecutive outpatients were assessed using the HoNO S and Global Assessment of Functioning (GAF) scales.

Results: It was feasible to administer HoNOS in day-to-day clinical practice. There was a statistically significant correlation between the HoNO S and GAF scores. Attenders at the outpatient department had significantly lower HoNOS scores compared to individuals assessed on domiciliary visits or at the day hospital. Individuals with schizophrenia had significantly higher HoNO S scores compared to affective disordered patients. However, this difference was confined to the Social subscale of HoNOS.

Conclusions: Although these findings indicate that HoNOS has significant convergent and criterion validity as a measure of psychiatric morbidity, its widespread use in day-to-day clinical practice may be premature.

Background: Care planning is a multidisciplinary process used to develop an individualised recovery plan for each service user. The success of this process will depend on the extent to which members of mental health teams can work with one another, with service users, and with other service providers in developing a coordinated plan that meets service user needs across multiple domains.

Aims: This paper examined the teamworking challenges that Community Mental Health Teams (CMHTs) face during the care planning process and how such challenges may be managed.

Method: A narrative review of published articles and policy documents relevant to teamworking and recovery-focused care planning within mental health teams.

Findings: Teamworking challenges include the provision of integrated rather than fragmented care, the empowerment of the service user, and development of a distributed model of leadership, responsibility and decision making.

Conclusions: CMHTs face a range of substantial but manageable challenges in attempting to implement recovery-focused care planning. Recommendations include the need to integrate recovery-orientated skills and values into professional training, the need for greater multidisciplinary training opportunities, and the need to evaluate CMHTs based on recovery-orientated criteria.

Objectives: This study examined the impact of psychiatric teaching on attitudes toward psychiatry of a cohort of medical students by means of a questionnaire survey. The impact of social desirability bias on questionnaire responses was also explored. Gender and nationality subgroups in the cohort were examined in more detail to determine whether these variables had any bearing on attitude change.

Methods: Fifth year medical students at NUI Galway completed the Attitudes to Psychiatry-30 questionnaire at the beginning and end of the psychiatric curriculum.

This was coupled to the Marlowe-Crowne Social Desirability Scale (13 items) to determine the effect of this potential bias on responses to the attitudinal scale.

Anonymity was ensured by using unique identification codes on the questionnaires, which facilitated individual comparisons of pre- and post-teaching responses.

Results: Attitudes toward psychiatry were positive prior to training but significantly improved following the teaching programme.

There was no difference in attitudinal change between male and female subgroups.

While students from outside the EU did show an improvement in mean scores on the ATP-30 this increase failed to reach significance. This finding was in contrast to the results for students from EU states whose mean increase on the ATP-30 was highly significant.

Social desirability questionnaire scores fell significantly between the first and second administration, lending support to the findings being a true reflection of the students' attitudes toward psychiatry.

Conclusions: These findings suggest that a teaching programme has the ability to influence students' attitudes. This is encouraging for recruitment into psychiatry and overall patient care.

Objectives: A quarter of people with schizophrenia may be classed as ‘treatment-resistant’. Clozapine is an antipsychotic that holds significant potential benefit for this patient group and has recently been recommended by the National Institute for Clinical Excellence. Early discontinuation is common. This study explores the factors that predict such discontinuation.

Method: This retrospective cohort design was carried out on two hundred and one people with treatment resistant schizophrenia who had commenced clozapine between 1990 and 1997 identified from the Clozaril Patient Monitoring Service (CPMS) in Northern Ireland. Clinical and socio-demographic data was collected for three years before and after commencement on clozapine. Kaplan Meier survival analyses were conducted to identify differences in discontinuation rates according to a range of variables.

Results: Forty-five per cent of patients had discontinued before three years. No difference in rates were found between men and women, nor whether side-effects were reported or not Patients who had commenced clozapine at an older age had significantly higher cessation rates. People who had started clozapine at age 50+ were four times more likely to stop taking clozapine within three years than people aged between 17-29 years.

Conclusions: Differences in continuation rates may be due to a number of factors. Treatment resistance may increase with age, side-effects may worsen or patient willingness to tolerate such effects may reduce. Alternatively, clinicians may be more anxious about prescribing clozapine as levels of co-morbidity increase. Further research is required to identify precise reasons and develop interventions to reduce discontinuation rates among older patients.

Objective: The objective of this article is to review the use of the opiate antagonist naltrexone as an alternative to opiate agonist maintenance in the treatment of opiate addiction.

Method: An extensive literature search, via Medline, Biosis, Psycinfo and other databases was carried out.

Results: Naltrexone has been used in the treatment of opiate addicts in a variety of settings. A number of methods of induction onto naltrexone of recently abstinent addicts have been used in different settings. Naltrexone has had a wide range of outcome success with different populations and associated treatment regimes.

Conclusions: The benefits of naltrexone can be compared with alternatives such as methadone maintenance and therapeutic communities. Naltrexone can be made more effective in the general population of opiate addicts with the use of adjunctive therapies.

The treatment of mental illness is undergoing a paradigm shift, moving away from involuntary treatments towards rights-based, patient-centred care. However, rates of seclusion and restraint in Ireland are on the rise. The World Health Organisation’s QualityRights initiative aims to remove coercion from the practice of mental health care, in order to concord with the Convention on the Rights of Persons with Disabilities. The QualityRights initiative has recently published a training programme, with eight modules designed to be delivered as workshops. Conducting these workshops may reduce coercive practices, and four of the modules may be of particular relevance for Ireland. The ‘Supported decision-making and advance planning’ and the ‘Legal capacity and the right to decide’ modules highlight the need to implement the Assisted Decision-Making (Capacity) Act, 2015, while the ‘Freedom from coercion, violence and abuse’ and ‘Strategies to end seclusion and restraint’ modules describe practical alternatives to some current involuntary treatments.

We report two cases of acute onset and rapid resolution of psychotic symptoms, the first following oral ingestion and the second following intravenous injection of some head shop products (HSPs). Both were associated with autonomic instability and negative results on urine toxicology screening using standard techniques. They highlight the potential dangers of managing such cases in acute stand-alone psychiatric units. Recent advance in characterising some HSPs by toxicology screening is also discussed.

Background: There is no published research on attitudes of psychiatrists towards children visiting parents who are acutely-unwell and inpatients in psychiatric hospitals. Nor is there information on facilities available for such visits.

Objectives: (I) To assess the attitudes of Irish psychiatrists towards children visiting. (II) To determine the availability of child-friendly facilities within admission units.

Method: A questionnaire was posted to every consultant psychiatrist accepting acute adult admissions in the Republic of Ireland and Northern Ireland.

Results: The response rate was 69%. Ninty-seven per cent were in favour of children visiting. Almost half felt that decisions on visits should depend on the particular situation, considering the child, parent, ward, etc. However, only 11% of units had a room/area designated for children visiting. 90% had no facilities they considered child-friendly on their unit. A majority felt that arrangements for children visiting were inadequate.

Conclusions: This topic is of interest to psychiatrists, and can be contentious, particularly when considering supervision of, and legal responsibility for, children visiting. Guidance on these issues would aid psychiatrists and hospital management. Poor facilities and infrequent visits may be a factor in the early development of stigma towards mental illness. Further research, improvements in facilities and staff training in liaison with children are needed.

The aim of this survey was to investigate the voting practices of patients on an acute psychiatric unit in the General Election 2011. Our survey showed that only 10% of patients voted and many patients were unaware of their right to vote. We recommend that all patients should be routinely informed of their right to vote as part of their hospital admission. Voting should be facilitated by hospital staff and advocacy where practicable.

Various problems can occur when embarking upon training in psychodynamic psychotherapy for the first time. If the difficulties experienced by trainees are not given serious attention by supervisors, trainees may give up at an early stage. This paper looks at the subjective difficulties experienced by three junior trainees in psychiatry in adjusting to such training, and includes comments in reply from one of the organisers of the course which the trainees attended. It is essential for supervisors to address trainees concerns openly, in order to avoid a further decline in the use of this important part of the “therapeutic armamentarium”.

Objective: To compare the quality of care offered by a community hospital hostel and three hospital rehabilitation facilities (two traditional rehabilitation wards and an innovative normalisation unit) for people with longterm mental illnesses.

Method: Quality of care is assessed here on three different levels: those of Input using Programme Analysis of Service Systems; Assessment of Care Environments; Process using Ward Management Practices Questionnaire; Attitudes to Treatment Questionnaire; Outcome using Rehabilitation Evaluation Hall and Baker and the Life Experiences Checklist and resident and staff questionnaires. These measures cover a range of perspectives from staff to residents, and include both standardised assessments as well as specific schedules developed for the study.

Results: On Input measures, the community hospital hostel had the best scores on the Programme Analysis of Service Systems schedule, which measures the degree to which services meet predetermined normalisation criteria. On the Assessment of Care Environments it also scored favourably against other community facilities. Process measures showed no differences between units in terms of their management practices, all scoring well, but suggested some differences in staff attitudes. Staff in the community hospital hostel had the most medical approach to care, however this was accounted for by the scores of untrained staff. Qualified nurses had a more psychological approach to care. Finally on Output measures, residents in the community hospital hostel were found to be the most disabled on the REHAB scale. Despite this, they had a significantly better quality of life as assessed by the Life Experiences Checklist. Staff in the community hospital hostel had the clearest perceptions of their roles, though there were differences again in how qualified and unqualified staff perceived their work. Residents were generally satisfied with services, though residents in the community hospital hostel and in the hospital normalisation unit had the highest satisfaction levels.

Conclusion: The results of this comparative evaluation show that a high standard of care, equal to or surpassing some of the best hospital provision, can be provided in the community. This is despite the fact that the residents in the community hospital hostel were more disabled. Community patients' quality of life is better in a number of domains than their hospital counterparts and even patients initially reticent about the move into the community report higher levels of satisfaction, especially regarding their home environment. There-were interesting differences between trained and unqualified staff in the community hospital hostel. Trained staff had a more psychological view of patient care and felt more supported and appreciated by the team than their untrained colleagues. The implications of these findings for community residential care are discussed.