Objectives: Although epilepsy and psychiatric disorder are known to be associated, little is known about the nature of epilepsy in psychiatric inpatients and how well psychiatrists manage psychiatric patients with epilepsy. The aim of this study was to describe the nature of epilepsy in patients at a large specialist independent psychiatric hospital and to audit the management of epilepsy using patients' records.

Method: Cross-sectional survey of inpatients and audit of clinical documents. Audit standards were derived from good clinical practice and UK guidelines.

Results: In total, 83/488 (17%) patients had a life-time history of epileptic seizures and 67 (14%) were receiving anti-epileptic drugs. The prevalence of epilepsy was 37% among brain injury patients, compared with 10-11% in adult male and female forensic patients and in the elderly and 2% in adolescents. Generalised tonic-clonic seizures predominated. Common aetiological factors were: traumatic brain injury, antipsychotics, cerebral hypoxia, cerebrovascular disease and learning disability. In 53/67 (79%) cases the care plan stated the patient had epilepsy but in only 20 (30%) was the seizure type recorded. For 30 (45%) there was no history of how epilepsy had been diagnosed. Of those patients with a history of status epilepticus, 5/15 (33%) had a readily accessible emergency treatment plan. The patient's last seizure was incompletely documented in 29/44 (66%) cases, while for only 7/67 (10%) patients was there documented evidence of a review of epilepsy management within the past year.

Conclusions: Epilepsy was common in this group of psychiatric inpatients. Documentation and management needed improvement and to be in line with national guidelines.

Medical audit was carried out to evaluate drug therapy in a cohort of depressed patients admitted to a functional ward for the elderly. A retrospective case note study was carried out in 61 consecutive admissions with a diagnosis of depression. Seventeen of the 41 patients (41%) with a diagnosis of Manic Depressive Psychosis were not taking antidepressant medication on admission. Of the 11 patients who received Electroconvulsive Therapy seven (64%) did so under Section 3 of the Mental Health Act. Four of the 41 patients (10%) with a diagnosis of Manic Depressive Psychosis were not on prophylactic antidepressants or lithium on discharge. Seventeen of the patients (28%) were taking benzodiazepine hypnotics on admission, and 14 of these were discharged on the same type and dosage. There were no patients on more than one type of antidepressant or antipsychotic at any one time. These findings reflect deficiencies in the general practice and specialist treatment of depressive illness in an elderly cohort. The need for on-going audit in this at risk group is emphasized.

We describe an unusual cause of autobiographical memory loss in a 55 year old man who presented with prominent memory loss for significant events in his life over a period of five years with evidence of patchy memory loss for events prior to this. It was associated with emotional lability and was complicated by a number of tragic events in his life in the previous four years. In addition there were a number of brief episodes (< 30 mins) where he would transiently lose his memory for events including for hours, days or months prior to the event. Neuropsychological assessment confirmed prominent autobiographical memory loss with minimal deficits in other domains. An electroencephalogram (EEG) revealed a simple partial seizure arising from the right temporal lobe, pointing to a diagnosis of Transient Epileptic Amnesia. He was commenced on anti-epileptic medication and responded both subjectively and objectively. There are approximately 94 cases of TEA described in the literature and the diagnostic criteria and postulated aetiology of this illness is discussed here. Clinicians need to have high index of suspicion of epilepsy when assessing a patient with prominent autobiographical memory impairments.

Bipolar disorder can emerge in the context of organic brain pathology. In the case presented, long-standing hydrocephalus was diagnosed in a man with relatively late-onset bipolar illness who presented initially with somewhat atypical, treatment-resistant depressive symptoms. Hypomania, followed by a rapid-cycling bipolar course, subsequently developed. This report reviews the association between bipolar disorder and hydrocephalus, and examines possible neurobiological mechanisms implicated in both conditions.

Objective: To examine the rate of cognitive decline and occurrence of dementia among patients attending a lithium clinic for those aged 65 years and over.

Method: Retrospective chart review of the cognitive function of 29 patients receiving maintenance lithium treatment attending the Dublin South East Old Age Psychiatry service, over a nine-year time period.

Results: Twenty-nine patients were included in the study (20 female, nine males), with a mean age of 79 years. Two patients had concurrent dementia. Six patients fulfilled ICD10 criteria for mild cognitive disorder and all of these patients also fulfilled revised consensus criteria for mild cognitive impairment amnestic subtype. Sixteen patients were commenced on lithium as an augmentation treatment for recurrent depressive disorder, 12 patients were on treatment for bipolar affective disorder and one patient on treatment for schizoaffective disorder. Patients had been receiving lithium treatment for an average of 109 months with follow-up by the service for a mean duration of 38 months. The initial mean MMSE score of patients at first presentation to the service was 26.9 (SD = 5.6) compared to a mean MMSE score 25.8 (SD = 5.8) (CI of change in MMSE score at 95% level = −2.1 and 0) at follow-up. The mean MMSE of patients with mild cognitive impairment prior at first contact with the service was 26.8 (SD = 3.2) and at follow-up was 26 (SD = 3.2) which was not statistically significantly different (p=0.40) (CI for change in MMSE at 95% level = −3.2 to 1.5). No patient had developed incident dementia during the follow-up period of the study.

Conclusion: The results tentatively suggest that lithium may have a protective effect against cognitive decline and a neuroprotective role in patients with concurrent affective disorder and cognitive impairment. Multi-centre prospective studies of cognitive function in patients attending lithium clinics are needed to examine the neuroprotective properties of lithium.

A 54 year old woman presenting to the psychiatric services with persecutory delusions, complex visual hallucinations and fluctuating levels of consciousness was discovered to have a meningioma occupying the cerebellopontine angle. The psychiatric symptomatology of cerebellopontine angle lesions is reviewed and the pathogenic mechanisms are explored in the light of the symptomatology observed.

Objectives: Second opinion is a medical opinion provided by a second physician/ medical expert after first receiving an opinion by another physician/ medical expert. Little is known about the provision of second opinion in Child and Adolescent Mental Health Services (CAMHS). This study describes the second opinion service provided by the Child and Adolescent Mental Health Services (CAMHS) in the South Wales region.

Methods: We undertook a survey of a second opinion service in Child and Adolescent Mental Health Services (CAMHS). We also assessed whether the recommendations made by the second opinion clinic were implemented by the referrers.

Results: The diagnoses were not changed in 68% of the cases but alternative treatments were suggested. In 90% of the cases the treatment recommended by the clinic was implemented and nearly 70% of the patients showed improvement with the recommended treatment.

Conclusion: A second opinion service can provide valuable support and expertise to CAMHS and the referred families.

Objectives: This study describes the social, demographic and clinical characteristics of all the new referrals in a mental health catchment area. This study aims to compare Irish and non-Irish service users in terms of their mental health needs and service utilization.

Method: Case notes were reviewed retrospectively to investigate demographic, clinical and service utilization parameters among new referrals to the psychiatric services in Galway, Ireland over a six-month period.

Results: One hundred and fifty-four new referrals, of whom 41 were non-Irish, presented over a six-month period. Results showed no difference between Irish and non-Irish service users in terms of socio-demographic variables. Alcohol problems and subsequent need for detoxification and counselling were significantly higher among service users from the new EU accession states with a significant impact on the duration of their hospital stay and the need for intensive psychiatric care.

Conclusions: There is an urgent need for enhanced resources for the delivery of mental healthcare to immigrants. Service utilisation and mental health needs are not explained merely by illness-related aspects in immigrant service users. Social and cultural factors have to be recognised in order to prevent disadvantages in psychiatric care.

A service based on the principle that the comprehensive mental health needs of a community can be more efficiently met by supporting the existing primary care services has been developed in the North Aylesbury Vale, Buckinghamshire, England. The Buckingham Project is a home-based mental health service and caters for a rapidly expanding rural community of approximately thirty five thousand people between the ages of 16 and 65 years. Professional support is provided to the services and care already provided by primary health care teams, social agencies and above all, by families. Specially trained nurses work as specialists within the primary care teams in the area. Initial consultation is provided on the day of referral, often in the patient's home. Cost effective management approaches are employed throughout. The emphasis is on early detection of major mental illness and immediate intensive treatment using cognitive/behavioural treatment methods, and targeted low dose medication where necessary. The approach differs from the traditional hospital-based specialist services.

Objectives: To examine the evidence concerning the recent developments in the genetics of schizophrenia.

Methods: An extensive literature search was performed and relevant papers were examined and analysed.

Findings: There is overwhelming evidence that schizophrenia shows familial aggregation. Recent molecular genetic studies support the presence of susceptibility genes on chromosomes 6 and 22. In addition, an association between schizophrenia, the dopamine D3 receptor gene and the 5-HT2a receptor gene has also been demonstrated.

Conclusions: Recent advances in DNA technology have paved the way for the detection of genes of major and minor effects in the aetiology of schizophrenia. If the presence of the recently identified susceptibility genes is confirmed, it is likely that these genes will be recognised in the near future.

First admissions for schizophrenia to inpatient psychiatric services in Ireland are declining. The reason for this decline has been debated and it has been proposed that it could be attributable to either a decline in incidence or to policy changes or to both.

Objectives: This study examines the trends in first admission numbers for schizophrenia in Ireland and the influence of gender and marital status on age at first admission over the time period 1971-2004.

Method: Data were derived from the National Psychiatric Inpatient Recording System (NPIRS) for the years 1971-2004 inclusive. All first admissions with a diagnosis of schizophrenia during these years were included in the analysis.

Results: The results showed a significant decline in the number of first admissions with the number of first admissions for males exceeding those for females. The average age of first admission was higher for females than males (p < 0.001). The average age of first admission showed a decline for males (p < 0.001), but not for females. Marital status was a stronger predictor of age of admission than gender (p < 0.001). Never married persons had a lower age of first admission than those married and the delaying effect of marriage on age at first admission was evident in males and females (p < 0.001).

Conclusions: An examination of first admission hospital data confirm male disadvantage in schizophrenia. The study highlighted a number of areas for future research which include examining gender differences in more refined diagnostic sub groups of schizophrenia and the monitoring of first contacts with community-based mental health services.

Objective: The aim of this study was to determine whether patients with possible Alzheimer's disease (AD) who do not meet criteria for vascular dementia but who nonetheless have clinical or radiographic evidence of cerebrovascular disease (CVD), differ in presentation or rate of progression from patients with probable AD.

Method: Baseline cognitive and functional scores were obtained from 154 patients who had either possible or probable AD. Repeat data after a 12 month interval were obtained on 73 of these patients. Baseline data and rates of progression were compared for probable AD patients and possible AD patients with evidence of co-existent CVD.

Results: The diagnostic groups did not differ at baseline with a mean mini-mental state examination (MMSE) score of 18.1. Comparison of the longitudinal data showed a mean annual drop of 4.1 points on the MMSE in both groups.

Conclusions: The patients with and without evidence of co-existent CVD did not differ either at baseline or prognostically suggesting that evidence of CVD does not affect the rate of progression in AD. However, further longitudinal studies using neuropathological criteria are warranted to determine whether such data can be interpreted in favour of including possible AD cases in clinical trials of probable AD.

With advancements in medical science over past decades, our aging population has increased substantially. Census studies in 2001 showed that 429,100 of the population of the Republic of Ireland were aged 65yrs and older, making up 11.2% of the overall population. While the overall population of the Republic is expected to remain stable over the next ten years, the demographic projections for the elderly population is for significant growth: numbers of over 65yrs are expected to increase by nearly 108,000 people between 1996 - 2011, comprising over 14.1% of the overall population. In particular, our communities will contain a much higher proportion of octogenarians and nonagenarians: at present 21% of our over 65's are 80 yrs or older; by 2011, it is projected that this number will increase to 25%. In tandem, the prevalence of dementia will increase.

In 2000, it was estimated that 31,000 people suffered with dementia in the Republic of Ireland, and this figure is expected to increase by 5000 cases per year between 2001-2011. The ultimate outcome of this demographic shift, will be higher demands on medical services for older people, especially geriatric medicine and old age psychiatry. This paper will focus on two particular aspects of management which will increasingly impact on the work of old age psychiatrists – medicolegal issues and management issues in dementia.

Objectives: To describe the psychosocial and clinical characteristics of children referred to a community-based child and adolescent mental health service, whose mothers reported that they took opiates during the pregnancy.

Methods: In a retrospective study, the case notes of all children whose mothers reported that they had been exposed to opiates in utero, and who were referred to the Department of Child and Family Psychiatry, Mater Hospital, between 2001–2003, were identified by maternal reports. Information was obtained on age, gender, referral source, socio-economic group, family type, number of siblings, involvement of community care services, nature of presenting problems, diagnosis, interventions offered, and treatment difficulties. Information was recorded anonymously.

Results: 15 children were identified, of whom nine were male. Most were found to be living with their mother alone or with their mother and a partner, and to be socially and financially disadvantaged. Their presenting complaints usually involved combinations of aggressive, hyperactive, and oppositional behaviour. Diagnoses included ADHD, a speech and language disorder, and an axis II disorder. Interventions were frequently unsuccessful because of parents' difficulties with attending appointments, and because of instability in the families' living arrangements.

Conclusions: These children, due to a complex interplay of biological and psychosocial adversity, are at serious risk of ongoing psychiatric disorders in childhood and adolescence, and for adverse outcomes in adult life. A prospective cohort study of all children born to opiatedependent mothers is necessary to quantify the level of risk and identify resilience factors.