Objectives: To identify whether a simple marker of nonpsychiatric health service contact (weight of general hospital case notes) is helpfulin identifying patients with evidence of psychiatric disorder in a medical and surgical population.

Method: Hospital case note review identifying evidence of past and current psychiatric disorder in patients with heavy, medium and low weight case notes. Responses to letters to general practitioners and review of local psychiatric hospital records were used to validate findings. Setting: A large general teaching hospital in the centre of Leeds, UK. Subjects: Random sample of 240 patients aged 16-65 attending general hospital medical or surgical teams as an inpatient or day patient between April 1, 1991 and March 31, 1992. Patients whose index admission was to the gynaecology or obstetrics unit were excluded. Main outcomes: Non-psychiatric service contact was measured by case note weight and thickness, lifetime admissions and number of consultants seen. Psychiatric disorder was identified using global judgements based on a standardised assessment of the case notes, and also general practitioner statements of current or past psychiatric disorder and record of contact with psychiatric services.

Results: In a detailed examination of 75 cases, 92% of patients with lightweight notes had solely physical factors to account for their presentations, compared to 88% in the middleweight group and 64% in the heavyweight group. Heavier case notes more often contained comments about psychiatric problems affecting the physical presentation (lightweight 8%; middleweight 20%; heavyweight 64%). Patients with heavy case notes more often had a history of contact with psychiatric services as confirmed by the GP or contact at local psychiatric hospitals (lightweight 28% middleweight 24% heavyweight 48%). Amongst the heaviest service users, patients with a psychiatric problem had seen a median of 12.0 lifetime consultants compared to 8.5 in those where a purely physical cause was present.

Conclusions: Patients who have heavy hospital case notes are more likely to have evidence of psychiatric disorder than those with lower levels of hospital contact and this is more likely to have an impact on their physical presentation and clinical course as judged by case note review using structured assessment criteria.

Hunger strikes in a custodial setting are complex to manage clinically, with associated legal and ethical complexities. Hunger strikes in Irish prisons have received, and are likely to continue to be the focus of, considerable media attention. Whilst there is an internationally accepted consensus ethical position, there is limited legal guidance available for psychiatrists to draw upon in such cases. In this paper, we review recent case-law and discuss the legal considerations in the management of prisoners on hunger strike.

Objectives: The most recent census of psychiatric inpatients (Daly and Walsh, 2006) examined the decline of the long-stay population (both new and old long-stay) from 1963 to 2006. The aim of the present study was to identify new long-stay patients (patients in hospital between one and five years) in the 2006 psychiatric in-patient census and follow them up one year later to determine the number remaining as inpatients, ie. not having been discharged

Methods: New long-stay patients were extracted from the 2006 psychiatric inpatient census data base and were followed up one year later.

Results: Sixty-eight per cent (315/460) of new longstay patients on 31/03/06 were still resident in units and hospitals one year later on 31/03/07, the majority in psychiatric hospitals Forty-two per cent (133/315) of patients had a primary diagnosis of schizophrenia, 13% (40/315) of depressive disorder, 11% (33/315) of organic mental disorder and 8% of intellectual disability (24/315). The number of new long-stay patients discharged or who died showed a sharp decline on previous years.

Conclusions: Unless current services are improved and extended as advocated in A Vision for Change, it will be a number of years before this population leaves psychiatric hospitals and such hospitals can close because of the lack of suitable alternatives. In accordance with policy recommendations, the continuing requirement for the development of specialised rehabilitation services to cater for the broad needs of those who remain in psychiatric hospitals is of the utmost importance.

Objectives: Agraphia is the loss or impairment of the ability to produce written language as a consequence of brain damage and is a well recognised feature of dementia. However there is no generally accepted classification of agraphic disorders. Our aim was to determine the influence of writing style, lettercase and sentence polarity of the writing component of Folstein's MMSE on the overall test score.

Methods: We retrospectively reviewed the ‘write a sentence’ request of Folstein's MMSE of 280 randomly selected patients attending a geriatric day hospital. We analysed four sentence characteristics: 1 Number of words, 2 Writing legibility, 3 Sentence polarity, 4 Letter case.

Results: 280 MMSE forms were examined, 165 were from female patients. Mean age was 81.7(± 6.6) years. Mean MMSE score was 21.6 (males: 21.9, females: 21.4). Significant correlation was detected between the overall MMSE score and both legibility and number of words. Legibility scores were significantly higher for females than for males (7.2 vs. 6.6, p < 0.03). The mean MMSE of females writing in lowercase was significantly higher than for those writing in uppercase (21.5 vs. 18.6, p < 0.05). The mean MMSE score of subjects writing sentences with a positive tone was significantly higher than that of those writing a neutral or negative sentence (22.6 vs. 21.0 p < 0.03).

Conclusions: We have demonstrated a relationship between the content and structure of the writing assessment aspect of the MMSE and the overall test score.

Objective: The objective of this audit to examine the effect of risperidone therapy in controlling some behavioural disturbances in people with learning disability.

Method: Retrospective analysis of various behavioural disturbances before and after beginning risperidone therapy (during the month before risperidone was started in each case, and during September 1994 in all cases).

Results: Risperidone was found to be effective in controlling various behaviour problems in 12 of 17 patients.

Conclusion: Risperidone may selectively influence behaviour problems secondary to possible underlying mental illness but not others. There was also some evidence that it was more effective in an average dose of 6-8mg/day, but was not beneficial in doses smaller or larger than this dose range.

Involuntary psychiatric admission and treatment in Ireland is chiefly governed by the Mental Health Act 2001. The Irish government announced a review of the 2001 Act in July 2011, and the Report of the Expert Group on the Review of the Mental Health Act 2001 was published on 5 March 2015. The report, which constitutes advice to the Minister for Primary Care, Social Care (Disabilities & Older People) and Mental Health, presents 165 recommendations relating to virtually all areas of the Act. It recommends that ‘insofar as practicable, a rights based approach should be adopted throughout any revised mental health legislation’ and that the principle of ‘best interests’ should be replaced by an alternative set of principles as follows: ‘the enjoyment of the highest attainable standard of mental health, with the person’s own understanding of his or her mental health being given due respect; autonomy and self-determination; dignity (there should be a presumption that the patient is the person best placed to determine what promotes/compromises his or her own dignity); bodily integrity; and least restrictive care’. The Report presents a series of other recommendations aimed at increasing multi-disciplinary involvement in key decisions, promoting human rights and strengthening inspections of community facilities. Overall, the package of measures outlined in the Report is complex, interesting and worthy of debate.

Mental illness has been long associated with denial of certain human rights, social exclusion and political disempowerment. Too often, the effects of adverse social, economic and political circumstances, along with stigma, constitute a form of ‘structural violence’, which impairs access to psychiatric and social services, and amplifies the effects of mental illness in the lives of sufferers and their families. Existing literature indicates that voting rates are low among people with mental illness and, whereas voting preferences in the mentally ill may tend towards the liberal end of the political spectrum, they do not differ dramatically from the overall population. Rates of voting could be improved by mental health service users, service providers, advocacy services and others through (a) improved awareness of voting rights; (b) provision of information, especially to inpatients; (c) assessments of voting capacity, where indicated, using standardised, well-proven tools; and (d) pro-active voter-registration programmes.

A modern regulatory framework for gambling in Ireland is urgently required. The Gambling Control Bill of 2013 represents a decent starting point in developing player protection and much needed treatment services and research facilities for Gambling Disorder. The drafting and enactment of the Gambling Control Bill of 2013 appears to have slipped from legislative priority. The sooner this bill is enacted the better.

Objectives: The aims of the study were to examine: i) whether sex offending in elderly people is a serious problem, ii) whether mental disorder or alcohol abuse occur in association with such behaviour, iii) how such behaviour is managed by the psychiatric service and iv) the outcome of such management.

Method: Referrals of people with sexually offensive behaviour to the North Dublin Psychiatry of Old Age Service from its inception in 1989 to date (1997) were examined. Information collected included: i) mode and reason for referral, ii) demographic, social and medical information, iii) psychiatric diagnosis, iv) management and v) outcome.

Results: Thirteen cases were identified in the eight year period. The sexually offensive behaviours included indecent assault, masturbation in public and lewd remarks. Diagnoses included vascular dementia, frontal lobe dysfunction, Alzheimer's disease, chronic schizophrenia, depression with alcohol abuse and ‘no psychiatric diagnosis’. Two patients had positive syphilis serology detected on dementia screening. Alcohol abuse featured in almost half of the cases. Regarding treatment, five were treated with oral cyproterone acetate and one with benperidol, and all of these had a good response. Three were treated with neuroleptics and also settled. Specific treatment was not indicated in three cases and forensic services were involved in a further three cases.

Conclusions: It is noted that most subjects had an underlying psychiatric diagnosis particularly organic brain damage. Management alleviated the problem in all cases with psychiatric disorder. Cyproterone acetate is clearly useful in management. This review highlights the importance of thorough assessment, diagnosis and management of sexually offensive behaviour in old age.

A one year cohort of referrals (n=178) to a primary care based psychiatric clinic in a large Health Centre is described. Fears that such a clinic might detract from treatment provided for psychotic patients seemed unfounded. Waiting time for assessment was short and patients were more likely to attend than at hospital based clinics. Admission rates were considerably reduced. Contact between patients and their general practitioner seems to continue at a high level even during psychiatric intervention but half of the “frequent attender” group cease contact. The pattern of attendance on follow-up suggests that many patients may receive unnecessarily long out-patient care.

The evidence to date suggests that such clinics provide a useful service but other aspects of quality of care require evaluation.

Objectives: To ascertain whether or not there had been any improvement in the registration of deaths in Co. Mayo, Ireland, since 1970. At the time is was shown that 7.5% of deaths, in a sample of parishes in the west of Ireland had not been registered.

Method: A list of all those who died and were buried in Co. Mayo in 1992, was obtained and compared with a list of deaths registered in that and subsequent years.

Results: One hundred and twenty eight deaths (11.5%) occurring in the county in 1992 had not been registered by the time of this study in 1997.

Conclusions: Non-registration of deaths continues to pose serious problems for research and for the planning of health services. It is suggested that the government introduce legislation to address the issue. Registration of deaths should be standardised throughout the EU.

Objectives: We present our experience of an annual research symposium for psychiatric trainees in Scotland. This paper aimed to consider trainees' involvement in research by examining firstly rates of publication and secondly the views of trainees.

Methods: A list of all presentations to the Senior Trainees' Annual Research Symposium (STARS) meetings 2007-2009 was compiled and a detailed search made of major research databases. A questionnaire survey examined the views of attendees at the 2009 meeting.

Results: Fifty percent of presented work achieved publication. Feedback from symposia attendees was almost universally positive.

Conclusions: At a time of debate on the value of research sessions as part of higher training and a recent reduction in time allocated to research in the UK, we report on a thriving annual meeting. Research symposia for higher trainees were valued by participants and may be one useful means of encouraging trainee research.

The failure to recognise the pervasive developmental disorders/autism spectrum disorders is probably not uncommon in adult psychiatry. Indeed some of the treatment-resistant chronic mental illnesses are due to the failure to make this diagnosis and apply more appropriate treatment.

Patients with PDD/ASD cause considerable diagnostic difficulties in both inpatient and outpatient adolescent and adult psychiatry. Clinical experience suggests that patients with PDD/ASD in adulthood have been misdiagnosed as having schizophrenia resulting in inappropriate treatment. Mesibov and Handlan state that the diagnostic situation is complicated because the characteristics of autism are less pronounced in older clients. It is critical that an accurate diagnosis is given because of the specific treatment implications. In the past decade there have been considerable developments in our understanding of autism. The importance of bringing the developmental viewpoint into adult psychiatry is now highly relevant. Unfamiliar diagnostic categories now have to be considered by adolescent and adult psychiatrists. Grounds for the deletion of adult psychiatric disorders, eg. simple schizophrenia from ICD102 may exist. Instead PDD/ASD disorder may need to be considered.

As the purpose of diagnosis is to ensure appropriate client management, it is essential that diagnostic criteria are continually reviewed in view of clinical observation and research developments. In this paper, diagnostic categories causing confusion are outlined, and that these are variants of the core deficit of autism is suggested. The major PDD/ASD diagnoses in adolescence and adulthood are listed below.

Two of the following are required for the diagnosis of autism:

Objectives: To examine the prevalence, psychiatric co-morbidity and management of psychogenic non-epileptic seizures (PNES) in patients admitted to a tertiary referral Epilepsy Monitoring Unit (EMU).

Methods: Medical records of patients admitted to the EMU between 2003 and 2005 were examined and data from neurological, neuropsychiatric and neuropsychological assessments were analysed.

Results: Over a three year period 224 patients were referred to the EMU and 44 (20%) were diagnosed with psychogenic non-epileptic seizures (PNES). A total of 13 people (6%) were diagnosed with both PNES and epilepsy. Of those diagnosed with PNES 34 (75%) were referred to psychology services for cognitive behavioural therapy (CBT) and 26 (58%) were followed-up by psychiatry services.

Conclusions: The prevalence rates for PNES and co-existing PNES and epilepsy are consistent with previous reports. Rates of psychiatric co-morbidity were less than would be expected in this clinical population. Clear evidence-based guidelines to manage people with PNES are required.

Fifty years ago, on July 13, 1955, Professor John Dunne delivered his presidential address to the annual meeting of the Royal Medico-Psychological Association in Dublin, focussing on the contributions of ‘the physical sciences to psychological medicine.’ In his address, Professor Dunne discussed (a) the principle of conditioning, and the work of Hans Selye, especially in relation to ‘General Adaptation Syndrome’ and the role of stress in producing psychosomatic symptoms; (b) cybernetics and the generation of partial models of cerebral functioning, such as Grey Walter's Conditioned Reflex Analogue and the Electronic Delayed Storage Automatic Computer of Cambridge and (c) the development of integrated, holistic models of cerebral functioning, that took account of advances in both physical medicine and psychoanalytic thought. Professor Dunne placed particular emphasis on the importance of basic scientific research and the development of broadly based models of psychiatric care, both of which were to play critical roles in the development of more scientifically-based, bio-psycho-social models of service provision in the decades to follow.

Irish medical schools attract an increasingly diverse student population and produce graduates who will practise in many parts of the world. There are particular implications in this for the planning and delivery of the undergraduate psychiatry curriculum. In all countries, mental health services struggle for equitable resourcing, and mental health care within general medical services remains relatively neglected. The traditional undergraduate psychiatry offering has been justifiably criticised for being excessively oriented towards secondary care when the vast majority of medical graduates will pursue careers in primary care or in specialties other than psychiatry. Recently published articles in the Irish Journal of Psychological Medicine address the current challenges and opportunities in providing an undergraduate experience that better prepares students for the mental health aspects of medical practice in a global context. We summarise and discuss these contributions and the recent Royal College of Psychiatrists publication Choose Psychiatry: Guidance for Medical Schools.

Objective: The aim of this exploratory study was to investigate the extent of suicide ideation, psychological maladjustment and views of mental health service support in a sample of secondary school pupils.

Method: A cross-sectional survey was conducted on a purposive sample of participants (n=93) recruited from a secondary school located in the south east of Ireland. Participants completed a Background Information Questionnaire (BIQ); the Suicide Ideation Questionnaire (SIQ); and the Reynolds Adolescence Adjustment Screening Inventory (RAASI).

Results: Approximately ten percent of participants displayed high levels of suicide ideation whilst one third reported having previously had suicidal thoughts; one quarter reported psychological adjustment difficulties, although these varied by age and sex. Participants' drug use and their levels of parental closeness were both individual factors that significantly predicted both suicide ideation and psychological adjustment. Females reported higher levels of parental closeness than males. Forty percent of respondents rated mental health support services as insufficient to meet their needs.

Conclusion: The findings raise serious concerns about the extent of suicidal thoughts amongst young people in Ireland; they also highlight a potentially important role for parents in this regard. Further research should ascertain national prevalence rates whilst appropriate school-based mental health education/promotion and support services should also be implemented.