Objectives: Some patients with mental illness have said that religion (whether institutional or private) provides them with resources to cope with their illness. The aim of the study was to examine the spiritual well-being and religious practices, beliefs and psychological morbidity of psychiatric patients (n = 41) compared to control groups of patients with chronic medical conditions (n = 40) and community controls attending their GP (n = 39).

Method: The study was a cross sectional survey. The study group were identified in psychiatric rehabilitation and day unit settings, the medical controls from a physical rehabilitation hospital and rheumatology outpatient department and the community controls from a GPs surgery. General Health Questionnaire-28 (GHQ-28), the Spiritual Well-Being Scale (consisting of religious and existential well-being subscales) and an open-ended Religious Survey Questionnaire were personally administered to the groups and information supplemented by casenote data.

Results: Although there were no differences between the groups on the measure of overall Spiritual Weil-Being or on the subscale of Religious Well-Being, the psychiatric group scored lower on the Existential Well-Being subscale (p < 0.001) and had higher scores on the GHQ-28 (p < 0.001). The psychiatric group had increased frequency of private religious behaviour (p < 0.05) (praying and reading the Bible) which were thought to be coping strategies. Existential Well-Being of the whole sample was positively correlated to religious beliefs (feeling close to God (F = 6,337, p < 0.001); believing everything is according to God's plan (F = 2,709, p < 0.05) and having a mission in life (F = 3,563, p < 0.05)) and to religious practice (attending church) (F = 3,489, p < 0.05). Regression analysis of the whole sample showed that 49.5% of the variance in Existential Well-Being could be predicted by the severe depression subscale of the GHQ, but an additional 9.6% of the variance in Existential Well-Being could be predicted by religious beliefs.

Conclusions: The psychiatric group expressed lower life satisfaction and purpose, and were more likely to be single and unemployed. Religious belief does impact on life satisfaction and could be considered as an adjunct in the management of some psychiatric patients.

Dr Séamus Mac Suibhne (Sweeney), consultant psychiatrist and writer, who died on 8 September 2019, was a unique, much admired figure in Irish psychiatry. His interests ranged from clinical care to philosophy, from medical education to history, from innovative technology to the natural world. He was a dedicated family man as well as a doctor, scholar and writer who moved between academic fields with ease and erudition. As a clinician, he consistently placed compassion at the centre of care. Séamus’s work appeared in the Lancet, BMJ, British Journal of Psychiatry, International Journal of Social Psychiatry and Irish Journal of Psychological Medicine, among other publications. He also wrote for the Guardian, Spectator, Scotsman and Times Literary Supplement. Séamus had a particular passion for better acknowledgement and treatment of mental illness among psychiatrists, and his compelling advocacy on this theme is one of his lasting legacies.

Objectives: De-institutionalisation and the expansion of community services have resulted in a reduction in the number of inpatient admissions in Ireland having fallen by 31% between 1986 and 2006. However, despite this, readmissions continue to account for over 70% of all admissions. The policy document A Vision for Change identified many shortcomings in the current model of provision of mental health services, making recommendations for the future development of community-based services with emphasis on outreach components such as homecare, crisis intervention and assertive outreach approaches. These recommendations are reviewed in relation to readmissions and the impact they may have on reducing the revolving door phenomenon.

Method: Three main intervention programmes essential to the delivery of an effective community-based service outlined and recommended by A Vision for Change, along with other pertinent factors, are discussed in relation to how they might reduce readmissions in Ireland. A series of Pearson correlations between Irish inpatient admissions rates and rates of outpatient attendances and provision of community mental health services are carried out and examined to explain possible relationships between increasing/decreasing admission rates and provision/attendances at community services. International literature is reviewed to determine the effectiveness of these intervention programmes in reducing admissions and readmissions and their relevance to the Irish situation is discussed.

Conclusions: Whilst A Vision for Change goes a long way towards advocating a more person-centred, recovery oriented and integrated model of service delivery, it is apparent from the consistently high proportion of readmissions in Ireland that there are still many shortcomings in service provision. The availability of specialised community-based programmes of care is as yet relatively uncommon in Ireland and uneven in geographical distribution. A considerable improvement in their provision, quantitatively and qualitatively, is required to impact on the revolving door phenomenon. In addition a re-configuration of existing catchment populations is required if they are to be successfully introduced and expanded.

A patient is presented who resorted to frequent hospitalisation to avoid economic hardships. Psychiatric assessment and admission relieved the medical unit but was achieved at the cost of a valuable psychiatric bed. The question is raised: Is psychiatric hospitalisation an answer?

We describe a case of primary progressive aphasia (PPA) in a 62 year old right handed Irish woman who had progressive speech and language difficulty over a period of six years. She continued to work for a remarkable length of time and lived independently managing all her activities of daily living. The case posed a diagnostic challenge because initial presentation was suggestive of a conversion disorder. She also displayed signs and symptoms which overlapped with a fronto-temporal dementia and possibly early Alzheimer's disease. In our discussion, we explore the possible reasons for this overlap and the implication for psychiatrists. The need for adequate and sensitive investigations and a multi-disciplinary approach cannot be overemphasised as PPA cases are easily missed depending on the stage at which the patient presents.

Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction to neuroleptic medication. Both the incidence and aetiology of the NMS are matters of considerable controversy. We present a clustering of cases of NMS in a distinct geographical area in South Wales. Five cases were reported in an eight month period in 1990 and more recently, a second cluster of three cases occurred in a three week period in November, 1991. We discuss some of the possible explanations for this apparent “epidemic” of cases in South Wales.

William Sealy Gosset [1876-1937] was a brewer in Arthur Guinness and Co. Dublin from 1899 to 1935 when he moved to London. In 1907, writing under the nom de plume Student he published his paper on “the probable error of a mean” which was later developed by R A Fisher into Student's test of significance now in everyday use in biology and industry.

Objective: The assessment of the personality status of Adolf Hitler using a structured interview schedule, the Personality Assessment Schedule, with two informants, one a psychiatrist with an interest in psychohistory and the other a historian with special knowledge of the Third Reich and Weimar Republic. Method: The Personality Assessment Schedule was given in two forms to the two informants at different times; on each occasion Hitler was assessed as he was in 1937. Results: There was considerable discrepancy between the ratings of the two informants, the historian recording less-personality disturbance in all areas of function, although correlations between the two sets of ratings were relatively high (R1 0.5-0.6), with rater bias accounting for the differences in severity. Both informants regarded Hitler as having a dissocial personality disorder (using the new ICD-10 criteria), but the psychiatrist's rating also scored the diagnosis of paranoid and histrionic personality disorders. Conclusions: Interview schedules which use informants to assess personality disorder can be of value in examining the personality status of historical figures.

In Ireland, traditionally, most public Adult Mental Health Services (AMHSs) had a small cohort of service users with eating disorders (EDs) in their service. However, over the last 5 years, the National Clinical Programmes have been encouraging Mental Health Services to develop ED programmes in each catchment area. This has culminated in a model of care for EDs for children and adults. It appears that in relation to AMHSs, meaningful inclusion of families/significant other(s) in ED programmes is somewhat inconsistent. This paper will discuss the possible impact of excluding or minimising family/significant other(s)’ inclusion. It will also outline a suggested approach of including families/significant other(s) in a meaningful way in an out-patient ED programme.

The impact of prenatal alcohol exposure is far reaching and transgenerational but is largely under diagnosed. This has been a major public health concern but remains an area that has lacked attention with regards service development and research in Ireland. There is a need for mental health professionals to have a good working knowledge of the range of deficits associated with prenatal alcohol exposure. Knowledge of these deficits will facilitate identification of affected children for early diagnosis and intervention. This paper reviews available literature on this topic using broad search criteria. The aim of this article is to create greater awareness among professionals working with children in Ireland considering the high rates of alcohol consumption and the fact that most cases of FASD present with chronic undiagnosed mental health problems.

The relationship between significant life events and pulmonary tuberculosis was studied with a view to ascertaining whether such events were more prevalent in patients with tuberculosis than in patients with other respiratory diseases. The study was carried out at Peamount Chest Hospital, Newcastle, Co. Dublin. Sixty-five patients with pulmonary tuberculosis and 45 patients with non-tuberculous respiratory diseases were interviewed. We found that there was a significant increase in life events in patients with active tuberculosis when compared with non-tuberculous patients.

Dr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.