Objectives: With increasing longevity, more people will develop dementia. These people will have a wide range of needs according to their circumstances. Services in the community struggle to meet these needs. This study aimed to identify needs of dementia sufferers attending the South Dublin Old Age Psychiatry service as rated by their carers, to assess the extent of unmet need and the implication of this.

Method: The carers of 40 community-dwelling people with dementia attending the service were interviewed by one researcher using the Camberwell Assessment of Need for the Elderly (CANE). This measures a wide range of needs over 24 areas, from personal care, to social, financial and psychological care needs. Qualitative information was also obtained from carers regarding services available and their accessibility. A measure of carer stress and satisfaction with help for this was also obtained.

Results: Overall, the highest levels of need identified (both met and unmet) were in the areas of psychological functioning (memory and psychological distress), followed by social needs in the areas of managing money, daytime activities, self-care, and looking after the home. Highest unmet social needs were in the areas of daytime activities, home care and managing money. For 23/24 domains, carers were satisfied rather then unsatisfied with help received. The areas of greatest dissatisfaction to them concerned daytime activities, household skills and self-care. Over half of the carers reported psychological distress.

Conclusion: High levels of need, both met and unmet were identified. Many identified needs related to the provision of community supports in the areas of selfcare, household skills and daytime activities, in addition to psychiatric needs. Assessment of needs is important to ensure adequate and responsive service provision, in keeping with the ethos of community care.

Objective: The aim of this study was to investigate the attitudes to medication in relation to insight, purpose in life, symptoms and sociodemographic factors among a cohort of stable patients with a diagnosis of schizophrenia and schizoaffective disorder.

Method: We included 70 patients with a diagnosis of schizophrenia and schizoaffective disorder attending a Dublin suburban mental health service. All participants were 18 years or older and were excluded if they had a learning disability, acquired brain injury resulting in unconsciousness, and psychosis secondary to a general medical condition or illicit substance misuse. All participants were given self report questionnaires which included Drug Attitude Inventory (DAI-30), Birchwood Insight Scale, and Purpose in Life test. Symptoms were assessed using the Scale for Assessment of Positive and Negative symptoms. All data was analysed using the Statistical Package for the Social Sciences.

Results: We found that 86% (n = 60) of the participants had positive attitudes to medication, and 82% (n = 58) had good insight into their illness. Only 27% (n = 19) were found to have a definite purpose in life. There was a significant negative relationship between attitudes to medication and delusions (r = -0.25, n = 70, p < 0.05) and a significant positive relationship between insight and attitudes to medication (r = 0.0.28, n = 70, p < 0.05).

Conclusion: Many factors are involved in the multifaceted issue of attitudes to medication. Researchers must realise that these factors do not remain constant and may change with time and over the course of illness and treatment.

We report a case of neuroleptic malignant syndrome (NMS) secondary to clozapine treatment in which re-introduction of two different antipsychotics led to elevation of creatinine kinase (CK) levels without associated symptoms of NMS. The significance of CK levels as a marker for NM S is discussed in the light of previous findings in this area. We suggest clinical guidelines for antipsychotic rechallenge after the occurrence of NMS.

Records of the war service disability claims for Australian Vietnam veterans in Tasmania (n = 751) were analysed to establish patterns of interrelationships between categories of disability. The predicted relationship between psychiatric disability and stress related skin disabilities was strongly supported and relationships between psychiatric and other medical disabilities were found. An exploratory principal components analysis produced three independent components which accounted for 21.2 percent of total variance. Component 1 was interpreted as a general military service component and components 2 and 3 were labelled as stress components. The most likely interpretation of the two stress components was that they reflect differences in profiles of records for disability claims depending on the time when the disability presented. The relevance of the findings is discussed.

The earliest signs and symptoms of manic relapse in eight bipolar patients after lithium discontinuation were changes in talkativeness, motor performance, self-confidence and sleep pattern; only two patients reported a change in mood. These changes were initially subtle and did not occur in patients who stayed well after stopping lithium. The lack of affective symptoms might result in clinicians ascribing the changes to the removal of the sedative and cognitive slowing properties of lithium, rather than signs of an impending relapse; similar changes may well occur in patients whose relapse is not associated with lithium discontinuation. Prompt early treatment with lithium (and additional thioridazine in some cases) resulted in only two patients requiring readmission, both for ten days. It is concluded that such symptoms may indicate an impending relapse and prompt treatment is recommended.

A case of Cotard's syndrome which resolved following two grand mal seizures is described. This case illustrates how organic factors can be aetiologically significant in psychiatric disease. It also illustrates the usefulness of convulsive therapy, whether prescribed or occurring via nature, in this rare disorder.

92 adolescents (mean age 13.8 yrs) at a North Dublin school completed the GHQ - 30 and the attitude to authority scale. A high level of psychological distress (as measured by the GHQ - 30) was found, with 44% of the sample reporting 6 or more symptoms. The majority of students (84%) however expressed pro-authority feelings. A negative correlation was found between the level of distress and positive attitude towards parents. The possible clinical relevance is discussed

During the course of imprisonment, whether on remand or when serving a sentence, people sometimes need to be transferred to a psychiatric hospital. In Ireland the only psychiatric hospital a person can be transferred to is the Central Mental Hospital (CMH).

We describe 627 prison transfers to the CMH between 1983 and 1988. The number each year varied from 99 in 1983 to 127 in 1988. The percentage on remand varied from 49% in 1984 to 31% in 1987 and 1986. The average age of sentenced prisoners was 28 years and 35 years in the case of those on remand. The diagnostic categories were as follows: Schizophrenia (31%), Reactive Depression (23%), Personality Disorder (25%), Mania (5%), Drug and Alcohol (8%) and Mental Handicap (4%). The longest average stay in the hospital was seven weeks for Mania and the shortest was three weeks for Reactive Depression. The largest proportion on remand was for Mania (79%) followed by Schizophrenia (58%). We make recommendations about legislation and the role of the catchment area psychiatric hospital.

Objective: It is now widely recognised that personality disorders play a significant role in psychiatric practice. This study was set up to examine the diagnostic accuracy of the assessment of personality disorder in normal practice by a multidisciplinary community mental health team when compared with a formal assessment using a structured interview.

Method: Forty-four patients originally assessed by team members of the Early Intervention Service (EIS), were re-examined using the Personality Assessment Schedule (PAS ICD-10 and original version) at a mean period of 16.3 months after first assessment. Specifically we tested the extent to which three personality disorder (PD) clusters (flamboyant, odd/eccentric, anxious/fearful) could be differentiated from either no PD at all or from the remaining PD clusters.

Results: As expected, both flamboyant and odd/eccentric PD clusters were much more easily differentiated from no PD at all (overall accuracy of 87 % and 85 % respectively) than from other PD clusters (corresponding accuracy of 65 % and 50%) . In distinct contrast, the anxious/fearful cluster was much less accurately differentiated from no PD (accuracy of only 52%) than from other PD clusters (accuracy of 85%).

Conclusion: The diagnosis of personality disorders in routine clinical practice is fraught with difficulties, especially when mental status symptoms closely resemble personality traits. The present results suggest that greater knowledge, training and experience can facilitate diagnostic accuracy.

Objectives: The aim of this study was to investigate the effects of topiramate (TPM) on cognitive function, specifically language, in patients with epilepsy, and to determine whether a specifically designed neuropsychological test battery can show such effects.

Method: Twenty patients taking TPM, 25 epilepsy controls (taking medication other than TPM) and 25 healthy controls were recruited. We used a specific neuropsychological battery, including measures of visual and verbal memory, attention, fluency and comprehension. Separate one way between group ANOVAs were performed for each neuropsychological measure.

Results: Bonferroni comparisons revealed that the TPM group performed significantly worse than epilepsy controls on digits forward (p<0.001), digits backward (p<0.05), controlled oral word association (COWA) (p<0.05) and token test (p<0.05). The TPM group also needed more multiple choice cues in the Boston naming test (p<0.05).

Conclusions: The present study indicates that 15% of the sample tested had impaired language abilities and raises interesting questions regarding the nature of this effect. Furthermore, we have identified some short neuropsychological tasks that can be performed in routine clinical situations that can reliably identify patients who have negative linguistic effects of TPM.

The emergence of a new youth mental health paradigm has challenged how we think about the provision of mental health care for adolescents and young adults. This editorial tracks the origins of this new paradigm within the field of mental health both internationally and in Ireland.

Objectives: The aim of the study was to evaluate buprenorphine as a detoxification agent for heroin dependence in an outpatient setting. Specifically we sought to establish the rate of completion of detoxification and retention in treatment, the duration of successful detoxification and dose requirements.

Methods: The study was an open prospective evaluation of routinely collected clinical data on the first 60 consecutive heroin dependent patients who underwent buprenorphine detoxification. A flexible dosing regime was adopted with the dose of buprenorphine being adjusted daily against the previous day's withdrawal symptoms.

Results: The majority of patients (40 (67%)) completed detoxification. The median duration of treatment for completers was 17 days (range 9-30 days) with 90% of detoxification episodes completed within 21 days. Patients were commenced on initial median dose of 4mg buprenorphine (range 2mg-6mg) and the median stabilisation dose for the sample was 10mg daily (range 6mg-14mg). The median final dosage of buprenorphine required by patients retained in treatment was 1.2mg (range 0.4mg-2mg). We found older patient age to be a significant predictor of treatment completion.

Conclusions: Buprenorphine was an acceptable and a feasible outpatient detoxification treatment option for heroin dependent patients. Based on the study findings we propose a standard 21-day fixed-dose detoxification schedule.

Suicide and attempted suicide are common phenomena amongst psychiatric inpatients and outpatients. Self-immolation or self-incineration are dramatic attention seeking events which may have religious or political significance. Deliberate self burning which incorporate these may also encapsulate elements of attention seeking, parasuicidal and suicide behaviour. The present study shows that psychiatric inpatients who choose to injure themselves by self burning are a seriously disturbed group whose intention is largely suicidal and who have a previous history of attempted suicide. They tend to be female, single, suffering from either schizophrenia or personality disorder in contrast to the majority of people who take their lives by other methods who tend to suffer from depression, alcoholism or both.

Disulfiram is widely used for the aversive treatment of alcoholism. It is well tolerated in most patients; however 1:15,000 will develop peripheral neuropathy, which is frequently misdiagnosed as alcoholic neuropathy. Most cases present with a motor-sensory neuropathy of the lower limbs, which tends to improve when administration ceases, though some cases may be left with permanent sequelae. This adverse reaction can be avoided by using the lowest effective dose. A literature review using the Medline revealed 66 citations relating disulfiram to peripheral neuropathy, and the number of cases reported is small.