Objectives: Drivers with certain mental illnesses are obliged by the Driver & Vehicle Licensing Authority (DVLA) to stop driving and to report their condition. This study aims to quantify the number of psychiatric patients failing to meet the DVLA standards of ‘fitness to drive’ and to record how frequently psychiatrists failed to advise patients of these standards.

Method: In this prospective descriptive study, 10 psychiatrists reported by questionnaire the diagnosis and driving status of all patients encountered over a four week period. They recorded their advice given to patients failing to meet the DVLA criteria of ‘fitness to drive’ and advice given when prescribing psychotropic medication.

Results: Of 297 patients, 123 (41%) were drivers. 19/123 (13%) of drivers failed to meet the DVLA standards of ‘fitness to drive’. In 9/19 of these cases the psychiatrist did not advise the patient in line with the DVLA guidelines. This was especially the case for alcohol related disorders. Of drivers 49% were prescribed psychotropic medication with potential adverse effects on driving.

Conclusions: Driving amongst mentally ill patients appears commonplace. In this study, 13% of drivers were considered by the authorities to be unfit to drive. Psychiatrists frequently used their own judgement when advising patients regarding driving. This arguably contravenes doctors' responsibilities to patients and has potential legal implications for both the patient and psychiatrist.

COVID-19 continues to exert unprecedented challenges for society and it is now well recognised that mental health is a key healthcare issue related to the pandemic. The current edition of the Irish Journal of Psychological Medicine focusses on the impact of COVID-19 on mental illness by combining historical review papers, current perspectives and original research. It is important that psychiatrists leading mental health services in Ireland continue to advocate for mental health supports for healthcare workers and their patients, while aiming to deliver services flexibly. As the pandemic evolves, it remains to be seen whether the necessary funding to deliver effective mental healthcare will be allocated to psychiatric services. Ongoing service evaluation and research is needed as the myriad impacts of the pandemic continue to evolve. In a time of severe budgetary constraints, ensuring optimum use of scare resources becomes an imperative.

Objectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.

Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 -February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.

Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.

Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.

A 57-year-old female patient with a diagnosis of schizo-affective disorder since 1986 was commenced on clozapine due to persistent positive and negative psychotic symptoms in September 2014. After commencement of clozapine she was delusion free and demonstrated an improvement in negative symptoms. Three months after commencement of clozapine she developed a hypersensitivity reaction. Her symptoms continued to deteriorate despite being prescribed an anti-histamine. Clozapine was discontinued 6 days after the appearance of a generalised pruritic rash, as it was believed to be the probable cause. There was complete resolution of symptoms 1 week after discontinuation of clozapine. Clozapine was replaced with olanzapine and amisulpride. There has been no similar cutaneous or allergic reactions for the past 30 months.

Objective: To assess the effect of specific psychoeducational sources – support group meetings, lectures and literature – on bipolar disorder patients' knowledge and attitude to their illness. Methods: Eighty bipolar disorder patients attending for a lithium blood test were asked to complete a questionnaire detailing their demographic characteristics, duration of illness, knowledge of manic-depressive illness and their attitude towards their illness and what exposure they had had to relevant support group meetings, lectures and literature on bipolar disorder. Results: The 43 group attenders had a statistically significant higher mean score on the illness and lithium knowledge and the attitude to illness sections of the questionnaire than the 30 patients who did nto attend groups (P<0.001). A multiple regression analysis indicated that, in addition to group attendances, only reading literature contributed significantly to illness knowledge and attitude. Age, sex, duration of illness and socio-economic status did not contribute significantly to these outcome variables. Conclusions: Bipolar disorder patients who attended support group meetings and availed of relevant literature knew more about their illness and lithium therapy and expressed more positive and realistic views about their illness than those who only read literature and attended lectures.

Recent reports from the Inspector of Mental Health Services have highlighted marked variations in electroconvulsive therapy (ECT) prescriptions nationally. This article reviews six international guidelines in order to assess the question of which patients should be referred for ECT treatment and at what stage in their illness. The guidelines display a general consensus in terms of the acutely and severely ill, but differ dramatically in terms of access to ECT outside this category, such as the moderately depressed patient who is treatment resistant but non-psychotic and non-suicidal and who requests ECT due to a previous good response.

The American Psychiatric Association guidelines strongly support the early consideration and use of ECT, highlighting the dangers associated with increased length of illness for individual prognosis. The National Institute of Clinical Excellence (UK) guidelines are the strictest, reserving ECT for the severely ill exclusively and only in cases with a demonstrable failure of alternative treatments. This confusion may ultimately need to be addressed by the Mental Health Commission as data relating to variations in practice may result in inappropriate reductions in access to an established treatment.

Objectives: Over the past three decades, major changes have taken place internationally in the type of residential accommodation provided for people with intellectual disabilities but these appear to be less evident in Northern Ireland.

Method: A census was undertaken of all persons in any form of residential placement using a range of existing databases to identify the population, with a short questionnaire completed for each resident.

Results: Around 440 persons lived in hospitals and 1,970 in some other form of provision but mostly in large congregated settings such as residential care homes and nursing homes. This was more marked in certain Health and Social Service Boards than in others. Most places are provided by the private sector although voluntary organisations and housing associations now manage around one-third of places. People living in hospitals reportedly had different characteristics to those in all other settings while those in nursing homes tended to require greater personal care. However the characteristics of people living in residential homes, supported living arrangements and village communities were broadly comparable. Around one in 10 persons were deemed to benefit from a move; mostly from residential homes to more independent living arrangements.

Conclusions: Compared to Britain and the Republic of Ireland there is an under-provision of residential placements in Northern Ireland. To date, funding from outside of health and social services has been the main driver for the type of accommodation provided. The implications for future policy and provision are discussed.

Objectives: To evaluate the sensitivity of the CAMCOG naming subscale to anomia in Alzheimer's disease (AD) patients identified as anomic on the Boston Naming Test (BNT); and to compare the sensitivities of BNT, category (semantic) fluency (CF), and episodic memory (Delayed Word Recall, DWR) in detecting AD.

Method: Data from 140 probable AD patients (NINCDS/ADRDA) were analysed. Anomic AD patients were identified (BNT) and the sensitivity to anomia of the CAMCOG naming subscale was calculated. Sensitivity (to AD) and specificity of the BNT, CF and DWR were compared in a subgroup of 60 patients age-matched to controls.

Results: On BNT 81% of ADs were classified as anomic (87% specificity). Of these anomic ADs, 23 scored 6/6 on CAMCOG naming (sensitivity = 80%), and sensitivity fell to 30% using a 5/6 cut-off. Correlation between BNT and CAMCOG naming yielded Kendall's tau = 0.48 (p<0.0001). Compared to age-matched controls BNT correctly classified 70% of ADs and 87% of controls (overall accuracy = 77%). On CF 68% of ADs and 83% of controls were correctly classified (overall accuracy = 72%). BNT and CF were moderately correlated (r = 0.49, p<0.0001). DWR correctly classified 93% ADs and 98% controls (overall accuracy = 95%).

Conclusions: Given its brevity, we recommend the inclusion of a split-half form of the BNT in screening test batteries for the detection of AD. The observed pattern of cognitive impairment is consistent with current models in which semantic memory deficits occur in AD only when the neuropathology extends beyond the entorhinal/hippocampal region to the temporal neocortex.

The Irish College of Psychiatrists recently reported that “the needs of people with learning disability and offending behaviour pose a huge challenge to service providers. The vulnerability of people with a learning disability who come into contact with the criminal justice system is well described and noted.” The College noted that “the population with learning disability who offend does not easily fit into existing services” and reported that “the majority of service providers strongly supported the urgent development of a forensic learning disability service.”

The challenges presented by individuals with learning disability and offending behaviour are not specific to Ireland or to this period in history. The purpose of the present paper is to explore issues related to learning disability and offending behaviour in 19th- and early 20th-century Ireland.

More specifically, this paper presents original, previously unpublished case material from the archival medical records of the Central Mental Hospital, Dublin in order to illustrate specific aspects of the institutional experience of individuals with learning disability who were charged with offending behaviour in nineteenth-century Ireland.

The Central Mental Hospital, Dublin was established as the Central Criminal Lunatic Asylum in 1845 under the provisions of the Lunatics Asylums (Ireland) Act (1845). Individuals were to be committed to the Central Criminal Lunatic Asylum if they were declared ‘guilty but insane’ at time of trial or offence, or if they developed mental illness and became difficult to manage while in detention elsewhere. The Central Criminal Lunatic Asylum opened its doors to admissions in 1850 and by 1853 there were 69 male and 40 female inpatients.

Health policy documents recommend screening for cognitive impairment, although in practice this is not implemented. This article looks at the issues which require consideration in implementing a screening programme. These include factors pertinent to the disease under consideration, resources, both personnel and time, lack of experience of cognitive screening at a primary care level, use of screening instruments and uncertainty about management of positive cases. Only by identifying the practical difficulties involved in screening, can steps can be taken to overcome them and to implement screening programmes which are acceptable to the population under consideration and their primary care physicians.

We describe the adaptation of services to allow flexible and practical responses to the coronavirus-19 (COVID-19) public health crisis by four Consultation–Liaison Psychiatry (CLP) services; Galway University Hospital (GUH), Beaumont Hospital, University Hospital Waterford and St Vincent’s University Hospital (SVUH) CLP services. This article also illustrates close collaboration with community adult mental health services and Emergency Department (ED) colleagues to implement effective community diversion pathways and develop safe, effective patient assessment pathways within the EDs. It highlights the high levels of activity within each of the CLP services, while also signposting that many of the rapidly implemented changes to our practice may herald improvements to mental health patient care delivery in the post-COVID-19 world, if our psychiatry services receive appropriate resources.