Since the establishment of St. Brendan's Hospital in 1815 many changes have been seen in the pattern of psychiatric illness but none as dramatic as that of neurosyphilis. When Professor John Dunne first worked there in 1922, 20% of the patients suffered from general paralysis of the insane (G.P.I.) for which there was no cure. Around this time Wagner Von Jauregg – a Viennese physician, observed that patients who had suffered malaria during war did not suffer from G.P.I. He introduced malarial therapy successfully for which he received the Nobel Prize in 1927. Professor Dunne introduced this therapy into St. Brendan's after visiting Wagner Von Jauregg in Vienna. Unfortunately the mosquitos used would not bite! He resorted to injecting malarial infected blood. Only benign tertian malaria was effective and it is believed that the high temperatures induced – 40-41°C killed the spirochaete. This was followed by quinine treatment for malaria. The treatment was very successful but superceded in latter years by penicillin. The incidence of syphilis fell dramatically from 1942-1977, although recently it has been reported that it is rising in females and heterosexual males.

One hundred consecutive samples routinely tested for syphilis (using the Venereal Disease Research Laboratory (VDRL) and Treponema Pallidum Haemagglutination (TPHA) test), between January and April 1988 were examined. Ninety-eight were negative for VDRL and TPHA. Two patients, both male, revealed evidence of previous infection i.e. VDRL neg, TPHA positive with Fluorescent Treponema Antibody tests (FTABS) reactive and FTA IGM negative in both cases. Neither of the two patients had any signs or symptoms suggestive of neurosyphilis.

Objective: To clarify the effect of age on behaviour disorders in adults with learning disabilities, and the differentiation of behaviour disorders from other psychiatric disorders.

Method: Detailed assessments, measuring maladaptive behaviours, psychiatric disorders and demographic factors were completed on 93.7% of all people with learning disabilities aged 65 years and over, living in Leicestershire, UK (n = 134), and also a random sample of adults with learning disabilities aged 20-64 years (n = 73). Behaviour disorders were distinguished from other psychiatric disorders. Descriptive and inferential statistics were calculated.

Result: Equal rates (15%) and types of behaviour disorder were found in the two groups. The presence of behaviour disorder was associated with the severity of learning disabilities, but age was not associated, and nor was presence of epilepsy or gender. In many cases, positive scores on the behavioural assessment, which carers attributed to challenging behaviour/ behaviour disorder, were actually symptoms of psychiatric illness.

Conclusion: Behaviour disorders persist into old age, and therefore require management from the appropriate services. This need will increase, due to increasing lifespan. The accurate interpretation of behaviour scales requires that a comprehensive psychiatric assessment is also undertaken, particularly in elderly people where rates of psychiatric disorders are higher than for younger adults.

Objectives: To examine the knowledge and experiences of side-effects and their monitoring in patients prescribed atypical antipsychotic medications.

Methods: A tick box survey was designed to ask questions of patients prescribed atypical antipsychotic medications about side-effects and monitoring for them. This survey was distributed anonymously to all suitable outpatient attendees over a three month period who had been prescribed atypical antipsychotic medication for at least one year.

Results: Seventy-four of the 90 surveys (82%) distributed were returned complete. Fifty-six (76%) of those surveyed said they were currently experiencing side-effects. Twenty-two (39%) said they had not told their psychiatrist about the side-effects. Weight gain was most commonly complained of (49%). Forty-five (61%) said that they had had no monitoring blood tests in the past year. Fifty-one (69%) did not know that certain monitoring blood tests were recommended.

Conclusions: Patients prescribed atypical antipsychotic medications are not currently being monitored as best practice dictates. It cannot be assumed that GPs will pursue this monitoring. More resources are needed for mental health services so that adequate monitoring services can be provided.

Diogenes syndrome or senile squalor syndrome has been described in the psychiatric literature with an associated mental illness in between one half and two thirds of the cases cited. The occurrence of the syndrome in the absence of a psychiatric disorder has received much attention with many hypotheses proposed. We present the case of a 72-year-old man living for many years in domestic squalor whose presentation, neuropsychological profile and history suggest an underlying autistic spectrum disorder. We are not aware of any similar case in an older adult reported in the medical literature. The co-occurrence of these two conditions is an intriguing one as certain key features of autistic spectrum disorder may predispose to Diogenes syndrome.

The literature on challenging behaviour is large, with heavy emphasis on behavioural approaches. In recent years more attention has been given to the effect of psychiatric illness on the behaviour of people with intellectual disability. However, theoretical differences between disciplines can lead to one or other approach dominating the assessment process. Increasingly, functional assessment is receiving attention as an assessment approach by both psychiatrists and psychologists. When used properly it can give a holistic overview of the individual and their behaviour, allowing a team approach to assessment and treatment that ensures the consideration of all possible psychiatric/medical/behavioural/environmental possibilities (a bio-behavioural model) in the aetiology and maintenance of challenging behaviour. This case study illustrates the effectiveness of teamwork in this area using functional assessment as a tool. The case also illustrates the possible futility of such comprehensive assessments of challenging behaviour in the absence of appropriate resources to implement the recommendations of such an assessment.

The paper makes a chronological review of the literature in the area of psychological intervention with cancer patients, focussing particularly on breast cancer as this is the disease which has attracted most attention from mental health profesionals. Initially, surveys which identify psychological distress in cancer patients are reviewed, as it is felt that these may have contributed the impetus for intervention. In the second half of the paper, interventions are classified and reviewed.

Sixty seven opiate dependent addicts receiving methadone maintenance completed the Beck Depression Inventory. A high level of depressive symptoms was found. Eighteen (27%) scored in the moderately depressed range while thirty eight (56%) scored in the severely depressed range. There was no statistically significant association between either sex or HIV status and level of symptom reporting. The clinical implications of depressive symptoms in opiate addicts are discussed.

An example of folie à deux with an uncommon clinical picture is presented. It concerns two spinster sisters, with no past psychiatric history, who became simultaneously manic while on holiday. The “Principal” was clearly deluded; the “Associate” shared these abnormal beliefs. After recovery and eighteen months later, one became depressed and the other shared her suicidal ideas, but this time the roles of the “Principal” and “Associate” were reversed. The shortcomings of the ICD10 and DSM-IIIR in classifying this syndrome are highlighted.

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

We describe 99 female prison transfers to the C.M.H. between 1983 and 1988. The mean age of the 70 sentenced prisoners was 26.43 years and that of the 29 remand prisoners was 33 years. The primary diagnoses were Schizophrenia (11), Mania (7), Depression and Stress (23), Personality Disorder (36), Mental Handicap (2) and Drug Addiction (16). The longest average stay at the hospital was for personality disorders (5 weeks). The longest sentences were for drugs offences. There were no cases of homicide or sex offences. We recommend that many of these cases could be handled in their catchment area hospital rather than in a high security Special Hospital.

A review was made of the case notes of all patients admitted to the Psychiatric unit of an East London teaching hospital in 1975, 1980 and 1985. Over the ten year period, the total number of admissions showed little change. In contrast, admissions associated with substance dependence tripled, and those related to substance induced organic mental disorder increased sevenfold. These findings suggest that psychiatrists in acute units should be on the alert to detect cases of psychiatric disorder complicated by substance misuse.

Objectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.

Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.

Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.

Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.

Objective: To establish time of presentation to paediatric accident and emergency (A&E) services of children with deliberate self-harm (DSH).

Method: All children presenting to an acute paediatric hospital with DSH or suicidal ideation between 1993-2003 were identified and time of presentation collected from their case notes.

Results: Of the 172 children where the actual time of presentation was recorded, the majority of children – 137 (80%) presented to the hospital outside of the ‘normal working hours’ of 9am-5pm, Monday – Friday. These children represent an at-risk group, and were more likely to have consumed alcohol, to have made a suicide attempt, and to have a family history of psychiatric illness than children presenting with “normal working hours”.

Conclusion: DSH in young people is a significant public health problem in Ireland and is a major risk factor for completed suicide. Access to an out of hours on-call Child and Adolescent Psychiatry (CAP) services is essential if these children are to have a mental health assessment, as recommended by the Royal College of Psychiatry and National Institute of Clinical Excellence. These services need to be urgently developed.

COVID-19 has presented society with a public health threat greater than any in living memory, leaving us to question almost every aspect of our society. An ever increasing concern is how we protect the global population from mental illness and whether public mental health policies can achieve this. In this article I reflect on the history of mental health service development, and furthermore on how COVID-19 might impact on the delivery of public mental health strategies into the future.

Perinatal mental health service development had early beginnings in the UK, and there has been rapid expansion over the past decade. As individual nations address need in their own jurisdictions, differences in service models and priorities have emerged. Innovative opportunities for addressing maternal and infant mental health needs must be balanced against the demands brought about by societal change and the COVID-19 pandemic. With such significant change, there is a unique opportunity for services and service planners to share good practice and learn from others’ successes and challenges.

Use of both cannabis and synthetic cannabinoids has been regularly linked to the development of psychotic illness. Thus, semisynthetic cannabinoids such as hexahydrocannabinol (HHC), which have a similar neurobiological profile to delta-9-THC, may also be expected to lead to psychotic illness. However, no such relationship has yet been reported in scientific literature. HHC is readily available online and in many vape shops in Ireland. Here, we present two cases of psychotic illness which appear to have been precipitated by use of legally purchased HHC and discuss its psychotogenic role and factors linked to its current widespread availability.

This paper sets out to briefly explore the definitions of two interrelated subfields of cultural anthropology; psychological anthropology and medical anthropology. This exploration will argue that culture and the individual are intimately intertwined. The theoretical evolution within psychological anthropology will be presented, from the bio-moral classifications of the ‘primitive’ to modern ‘experience near’ ethnographies, and fluid understanding of personhood. Theoretical and methodological approaches to mental health will be discussed briefly. Finally, the conclusion will ask the question: what is the future for medical and psychological anthropology?

Objective: Review of literature on non-compliance with medication in psychiatric patients.

Method: Computer and manual search of English language literature on non-compliance with drugs, psychiatric disorder, and phenomena which may be related, such as readmission and discharge against medical advice.

Results: The literature is discussed and a tentative checklist of risk factors for non-compliance is offered, as is advice on ways in which the problem may be minimised. It is noted that there is an emphasis on major mental disorders in the published literature.

Conclusion: There is no stereotypical defaulter. A high index of suspicion is essential. As far as possible, the patient should be educated to share in the responsibility for treatment, and concerned relatives and others can often play a pivotal role. More research is required on compliance problems in the minor psychiatric disorders. Close liaison with the general practitioner is vital.