Reflective practice is increasingly being recognized as an important component of doctors’ professional development. Balint group practice is centered on the doctor–patient relationship: what it means, how it may be used to benefit patients, and why it commonly fails owing to a lack of understanding between doctor and patient. The COVID-19 pandemic led to unprecedented disruption to postgraduate medical training programs, including the mandatory Balint groups for psychiatric trainees. This editorial reports on the experience of online Balint groups in the North West of Ireland during the COVID-19 pandemic, and furthermore provides guidance for online Balint group practice into the future.

Objective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.

Reports from the United States have linked fluoxetine with suicidality. As a result, litigation is pending, and the matter has recieved much media attention. There is no acceptable evidence to support the hypothesis that fluoxetine promotes suicide.

Multiple personality disorder (MPD) is being diagnosed with increasing frequency, especially in North America. However, soaring estimates of its current prevalence are accompanied by considerable controversy and heated debate. The author presents a number of grounds on which it seems reasonable to base a sceptical view of the validity of this disorder as a naturally occurring diagnostic entity.

There is broad agreement in the literature that depression in the community dwelling elderly is under-diagnosed and under-treated by general practitioners. Somatisation, overlap with medical illness, bereavement and atypical presentations of depression in this age-group may contribute to the difficulties in diagnosis in primary car settings. Furthermore, the apparent reluctance of primary care physicians to treat depression in the elderly may reflect the mistaken notion that depression in this population is a benign condition, an understandable reaction to physical illness and as such untreatable. Fundamental changes in the patterns of collaboration between psychiatry and general practice will be necessary to overcome these barriers to the detection and treatment of depression in the community dwelling elderly.

Objectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.

Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.

Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)

Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.

Objectives: To investigate whether placebo effects may vary in strength, depending on appearance of the medication.

Method: Polish subjects were randomly given different kinds of pills and told that the medicine was produced abroad or in Poland and that it was cheap or very expensive. Measures of different forms of well-being were taken directly after the ‘therapy’.

Results: Subjective ratings were higher for subjects who received big white or small red medicine compared to subjects who received small white or big red pills. The results are discussed in the light of the subject's previous experience with drugs of different kinds.

Conclusion: It was shown that placebo effects do vary in strength, depending on the appearance of the pill.

This paper investigates the characteristics of those under inpatient psychiatric care in 1901 in the context of a policy formulated to provide institutional care and treatment for mentally ill persons. It presents data on admissions, discharges and deaths, their demographic and clinical characteristics and reported outcomes.

A significant minority of cases of Huntington's disease commence before the age of 20 years and these juvenile cases are more likely to demonstrate paternal transmission and a clinical picture dominated by rigidity. Genetic research and positron emission tomography may make early diagnosis easier but predictive testing in childhood is replete with serious problems. There is no specific treatment for this fatal disorder. Juvenile Huntington's disease has a similar pathology and biochemistry to the adult condition despite a shorter course and certain clinical differences, such as rigidity and convulsions. Racial differences are explored.

Objective: To determine whether the previously reported relationship between menstruation and emergency psychiatric admissions still pertains.

Method: All females admitted on an emergency basis to a general psychiatric unit of a DGH, were interviewed and data regarding menstrual function was collected on those fitting the inclusion criteria who consented to inclusion in the study.

Results: Ninety three people were included in the study, of whom significantly more were admitted in the late luteal and menstrual phases of the cycle. Symptoms suggestive of premenstrual syndrome were significantly commoner in those admitted in the late luteal and menstrual phases.

Conclusions: The findings suggest that the premenstrual syndrome is either a risk factor for psychiatric admission or is important in determining the time of admission. Adequate detection and treatment of premenstrual syndrome, could in theory, reduce some psychiatric admissions. The methodology and limitations of the study are discussed.

Objective: The aim of this paper is to assess the level of agreement between clinical estimates of suicidal intent based entirely on information recorded in the Accident and Emergency acute assessment and Beck's Suicide Intent Scale (SIS) scores.

Method: As part of the WHO/EURO Multicentre Study of Parasuicide, cases of deliberate self-harm (DSH) in Cork city hospitals were monitored. Over the period 1995-1997, the information recorded in the Accident and Emergency acute assessment was examined by a psychiatrist and, if possible on the available evidence, clinical estimates were made at three levels of suicidal intent: minimal, moderate and definite. Seventy-nine of these cases had fully completed Beck's SIS. Statistical comparison was made between the results of the SIS and the clinical estimate of suicide intent.

Results: The agreement (Kappa = 0.146, p = 0.046) and concordance (Lin's concordance coefficient = 0.330, p = 0.001) between the two ratings are statistically significant but both are low. The overlap between those identified as high or low intent is low.

Conclusions: These findings indicate low agreement between a clinician's rating of suicide intent based on clinical records and Beck's SIS. This is especially relevant given the increasing reliance on psychometric instruments in assessment in psychiatry. However, further investigation is necessary to clarify which is the more valid method.

Objectives: Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects.

Method: Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service.

Results: There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification.

Conclusions: Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.