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.

Capacity legislation in Ireland is evolving. The Assisted Decision-Making (Capacity) Act 2015 has been passed into law, but its main provisions are yet to be commenced. This paper compares the law and its practical implications currently and under the new legislation. Quick reference algorithms for frontline clinicians are proposed.

Objective: The relationship between early adverse experience and psychological illness has been studied in younger adults, but not in the elderly. This study investigated early adverse experience in elderly women with a history of severe depression by using a semi-structured interview.

Method: Women admitted with a history of severe depression were identified and interviewed using the Brief Parenting Interview (BPI)(n=14).

Results: The majority of elderly women (71%) with a history of severe depression had suffered significant childhood trauma. Eight (57%) women reported parental loss, six (49%) reported tension or discord in the family home and one woman reported severe child sexual abuse. The majority of the women (87%) did not find the questionnaire distressing and all found it acceptable.

Conclusions: Considering the high prevalence of childhood trauma in this group and the problems treating severe depressive illness in the elderly, this area deserves further study. The BPI is well tolerated in elderly women with a history of depression.

We report the case of a patient with unilateral left-sided auditory hallucinations in association with a left middle ear infection, who in addition demonstrated a symptom of passivity, attributing the infection to the actions of a voice. The case demonstrates the potential for complex interplay between physical and mental pathology.

Lofepramine at the upper limit of its therapeutic range (210mg/day), was associated with the development of sinus tachycardia with atrial ectopic beats and progression of right bundle branch block to trifascicular block in an 82 year old man with a history of heart disease. As with any antidepressant administered in a high therapeutic dose, caution and regular electrocardiographic monitoring of elderly patients with heart disease receiving lofepramine is recommended.

Objectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome.

Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made.

Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement.

Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.

Electroconvulsive therapy was introduced in 1938 by Ugo Cerletti (1877-1963) of Rome in association with “young Dr. Bini”. Cerletti's training and his development of the electrical technique as an alternative to chemically-induced convulsions are briefly outlined.

We report the case of an 85 year old woman, admitted to hospital with a two month history of a depressive illness. Within one week of commencing treatment with citalopram 20mg daily, she had developed a widespread rash, bilateral ankle oedema and a range of biochemical and haematological abnormalities, including marked elevations of plasma urea and creatinine and increased neutrophil and eosinophil counts. Following withdrawal of citalopram, her physical state returned to normal within two weeks. The episode is suggestive of acute interstitial nephritis triggered by citalopram, a phenomenon not previously reported in association with the selective serotonin reuptake inhibitors.

To determine if a consultation/liaison mental health clinic in primary care as proposed for Vision for Change, The Primary Care Strategy and the Department of Health is an efficient model of delivering mental health care in Ireland.

Methods: The pattern of service use and the clinical characteristics of new patients attending a pilot consultation/liaison clinic in a local primary care centre were studied.

Results: During the first 16 months of this clinic 1.2% of patients did not attend the initial assessment in the liaison clinic versus 29.75% in the regular Outpatients Department (OPD). Less than one in five (17.1%) required a follow-up review with the clinician in the consultation/liaison clinic compared to almost all patients first seen in OPD secondary care (96.6%). A small minority of patients (6.1%) needed referral to secondary care due to the complexity of their presentation.

Conclusions: A consultation/liaison mental health clinic in primary care results in an efficient use of manpower resources due to the low Did Not Attend (DNA) rates and low proportion of formal referrals to secondary care. As patients seem to favour this type of setting, over traditional outpatient departments, a move towards consultation/liaison clinics in the primary care team should be considered.

Minor aggression is common in a closed female villa in a hospital for the mentally handicapped. In this study it occurred most frequently between 8a.m. and 10p.m. with a lunch-time peak. More incidents occurred on Saturday than on any other day. Few of the patients were psychotic and incidents were related to meal-times and reduced supervision. The most common targets for aggressive behaviour were property and the patient herself. The most common locus for aggression was outside the Sister's office. Attention to improving communication skills and providing more supervision should help to reduce the level of aggression.

Suicidal behaviour is a major public health problem worldwide, both with regard to mortality and treatment of clients who have deliberately harmed themselves. It is a multifaceted problem resulting from complex interactions between social, biological and psychological factors. There is insufficient evidence on which to make firm recommendations about the most effective forms of treatment This is remarkable considering the extent of the problem worldwide, and the importance of dealing with it appropriately in order to prevent further suicides.

People with obsessive-compulsive disorder (OCD) typically experience their relationships with others with a high level of trepidation and bring their anxieties into their work with professionals. We have written this paper to describe experiences of working with people with diagnoses of OCD and the impression that we have formed about the kinds of relationship that builds up in the early stages of this work. We believe that it is important to consider the quality of these professional relationships because of their impact on the patient's ability to benefit from whatever intervention we propose. Here, we place particular attention on the roles of magical thinking, disturbed relationships and the fear of rejection. The perspective presented here is designed to complement those of other approaches to OCD – including the neurological, behavioural and cognitive-behavioural. The following themes relating to the social and interpersonal experiences of people with OCD are examined here: (a) their general tentativeness and uncertainty in social interactions, (b) their fear of being damaged by others in social interactions, (c) their magical thinking relating to damaging others.

Selective serotonin reuptake inhibitor induced mania has been described in adults, and more recently in adolescents. To the authors' knowledge a case in pre-adolescents has not yet been published in the literature. The authors would like to report two cases of SSRI-induced mania. Both cases were pre-adolescent girls, A and B, who had a DSM-IV diagnosis of panic disorder, and were treated with paroxetine.