The clinical and pathological features are described in a case of prolonged dementia in a 59 year old man with familial dementia and extrapyramidal disorder. Postmortem examination showed severe fronto-temporal and basal ganglia atrophy, with many “ballooned neurons” in the residual cortex most likely representing Pick's disease. The differential diagnosis is discussed and aspects of this rare condition are reviewed.

Objectives: To describe an entire long-stay hospita population and examine the differences between the old and new long-stay groups. It outlines the communitybased facilities required for hospital closure to occur.

Method: One hundred and twenty-four patients were assessed using the Community Placement Questionnaire (CPQ), a standardised instrument used in service planning.

Results: The CPQ revealed a globally disabled group with multiple handicaps. The mean age was 68.7 years and the predominant diagnosis was schizophrenia. Though the old long-stay (74) were more disabled than the new long-stay (50), similar sheltered accommodation was required for both groups. The new long-stay required a more active day-care program.

Conclusions: Reprovision for long-stay patients must not only include sheltered accommodation but also appropriate day-care facilities. Assessment of the placement needs of all categories of long-stay patients necessary before hospital closure can take place.

Objective: To assess the outcome of treatment, a cross section of women from seven inpatient centres treating alcoholics were interviewed twice: as they entered treatment (n=114) and one year later (n=74) when they returned to the community.

Method: The patients were interviewed as they began treatment and 65% were traced for interviews one year later. Measures of self esteem, emotional health and drinking patterns are presented over time.

Results: Approximately one half of the women were abstinent when interviewed again and improved emotional health was related to abstinence. Of those who continued to drink many reduced their intake. A logistic regression analysis was applied to the data to explain the results. Among the major findings was the ability of therapists to predict subsequent drinking with a high degree of accuracy.

Conclusions: All of the services have abstinence as their goal. This could be challenged since at follow up only half of the women are abstinent. Controlled drinking may well be a valid objective if abstinence fails or could well be a valid objective for some patients.

Objective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.

We report a case of the Capgras Syndrome in a 67 year old woman who was found to have a glioma of the left frontal lobe. Our case illustrates the multiplicity of possible aetiological factors which frequently coexist in this condition and make any assessment of possible pathogenetic mechanisms difficult. However, there appears to be a consensus of recent neuro-imaging studies that frontal lobe pathology may be important. The possible relevance of this is discussed together with a suggestion for further elucidation of the origin of the delusion.

Objectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.

Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.

Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.

Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.

We describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.

The use of complex psychopharmacological regimens is increasingly advocated in more difficult to treat depressive illness. The combination of venlafaxine with mirtazapine – ‘California rocket fuel’ is one such example involving an SNRI combined with a NaSSA. We describe two cases that highlight the potential usefulness of duloxetine used in combination with mirtazapine that also emphasise the danger of drug-induced hypomanic switching. This combination may have a specific role for carefully selected patients but caution is needed given the potential to induce profound alterations in mental state.

Balint groups are now mandatory for psychiatry trainees. Balint groups have been in existence in General Practice for several decades. Providing Balint groups for Psychiatry Non Consultant Hospital Doctors brings with it challenges for the group leader and participants. Many of these challenges are common place in any form of group work, while others are unique to this cohort. This article describes these challenges. Guidelines which offer the the group the best chance of success, in the face of these common challenges, are discussed.

Climate change poses an existential threat to our planet and our health. We explore the intersections of climate change and mental health which has been under-recognised to date. Climate change can affect mental health directly through the effects of extreme weather events such as heat, drought and flooding, and indirectly through increasing rates of migration and inequality. Vulnerable individuals with neuropsychiatric disorders will be particularly at risk. Emerging evidence is also showing effects of air pollution on brain development. Mitigation efforts related to reducing carbon emissions will have both direct and indirect effects on mental health. A further consideration demonstrated by the COVID-19 pandemic is that the spread of infectious disease can have substantial effects on the mental health of the population. With climate change and biodiversity loss, pandemics could recur in the future with increasing frequency. It is now essential that mental health professionals be equipped as agents for climate action.

Objectives: To assess whether transition from the Mental Treatment Act (MTA), 1945 to the Mental Health Act (MHA), 2001 has had any impact on the clinical profile of patients in the West Galway Mental Health Services who are admitted on an involuntary basis.

Methods: Data were collected from clinical records in relation to all those individuals residing in the West Galway Mental Health Services who were admitted involuntarily in the 12 months prior to and subsequent to the introduction of the MHA 2001.

Results: A total of 175 individuals were included in this study (n = 91 - MTA 1945; and n = 84 - MHA 2001). No significant differences were found between the two groups in relation to demographic data, rates of involuntary detention or duration of involuntary detention. The applicant was less likely to be a family member under the MHA 2001 (54%) than the MTA 1945 (85%).

Conclusions: Transition from the MTA 1945 to the MHA 2001 has had minimal impact on the admission rates, clinical profile or duration of detention of patients admitted involuntarily in the West Galway Mental Health Services.

Single photon emission tomography (SPECT) is the prototypical tool for measuring cerebral blood flow (CBF) in discrete areas of the brain. Compared with when a male ‘crack’ cocaine user received placebo, oral cocaine (1mg/kg) ingestion was associated with non-uniformity of overall CBF with hypoperfusion of discrete brain regions, particularly of the frontal, temporo-parietal, basal ganglia, and thalamic areas. While these results should be viewed as preliminary, they do suggest that oral cocaine use may be associated with CBF abnormalities in ‘crack’ users.

One hundred and twenty-seven white male alcoholics, treated in a rural setting, were assigned to one of two groups. Seventy-three subjects received intensive aftercare by Community Psychiatric nurse and fifty-four control subjects received standard aftercare with outpatient appointments. Subjects were assessed one year after treatment. Fifty-four per cent of those given Community Psychiatric Nurse follow-up were completely abstinent compared with twenty per cent of those in the control group. Those receiving Community Psychiatric Nurse follow-up were less likely to have blackouts, hospital admissions or marital discord in the year following treatment. They were more likely to attend hospital meetings regularly. This form of aftercare is an effective way of maximising the benefits of expensive inpatient treatment.

Objectives: A significant number of depressed individuals experience inadequate benefit from long-term antidepressant use. This paper investigates the hypothesis that in some individuals persistent use of antidepressants may be prodepressant.

Methods: Literature regarding the effect of long-term use of antidepressants was reviewed by searching PubMed and Ovid data bases with terms: antidepressant tachyphylaxis, treatment-resistant depression, chronic depression and antidepressant tolerance.

Results: Antidepressant treatment-resistant patients frequently had a positive initial response to antidepressants. When resistance appeared, initial increases in dose or medication changes usually resulted in transient improvement. Eventually, the episodic course of the original depressive illness was replaced with a continuous, unresponsive depressive syndrome. We propose the term tardive dysphoria to describe this phenomenon.

Conclusions: The phenomenon of antidepressantinduced depression, or tardive dysphoria, needs to be experimentally examined in blinded, randomised antidepressant discontinuation studies.

As the COVID-19 pandemic escalates worldwide, it is apparent that many patients with more severe illness will also experience delirium. These patients pose a particular challenge in the application of optimal care due to issues with infectious risk, respiratory compromise and potential interactions between medications that can be used to manage delirium with antiviral and other treatments used for COVID-19. We describe a guidance resource adapted from existing guidelines for delirium management that has been tailored to the specific challenge of managing delirium in patients with COVID-19 infection. Issues around the assessment and treatment of these patients are examined and distilled into a simple (one-paged guidance resource that can assist clinicians in managing suspected delirium.