A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.

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.

Objectives: This study examines (1) what are the minimum accepted baseline investigations recommended in the literature prior to prescribing in child psychiatry and (2) whether these investigations are routinely performed.

Method: Medical literature on prescribing in child and adolescent psychiatry was reviewed, and a list of minimum baseline investigations recommended in the literature was established. A postal survey was performed to establish what current clinical practice is among child and adolescent psychiatrists. Current practice was compared with the recommendations in the literature.

Results: There are nine minimum accepted baseline investigations which are consistently recommended in the literature on child psychiatry. Six investigations are routinely performed by over 75% of respondents. However only 30% (n = 16) reported that they ‘always’ carried out eight or more of the nine recommended minimum investigations.

Conclusions: A consensus statement is necessary, providing a list of recommended investigations prior to prescribing in child and adolescent psychiatry. Continuing medical education can then highlight the importance of these investigations.

We present the case of a 68-year-old lady with a background diagnosis of bipolar disorder, who developed significant episodes of intractable delirium during each of her last three inpatient psychiatric admissions, where she was admitted with mania and psychosis. The case demonstrates diagnostic and management difficulties secondary to this delirium. We discuss the probable cause of this delirium and the various management strategies utilised in an effort to ameliorate her condition.

Many Irish graduates chose to pursue specialist psychiatric training in Britain. Regulations governing UK specialist training are currently changing in response to European Union (EU) directives. Furthermore, over the past five years the UK national health service has undergone significant reforms. This paper reviews the current status of British postgraduate training and examines the options for Irish doctors who take this route to a career in psychiatry.

This article outlines the development of the role of the Health Service Executive Authorised Officer in Ireland, the professional applicant for the involuntary admission of an adult to hospital beyond that which was envisioned in the Mental Health Act 2001.

This paper describes the perspectives of a service user academic and a psychiatric trainee in response to their engagement in service user supervision, now offered as part of our psychological medicine education, as a feature of an innovative service user-led, recovery and human rights focused, contact-based education programme. The supervision, being deliberately focused on exploring and addressing responsiveness to the traditionally underprivileged service user’s perspective, and hence vastly different to clinical supervision, was acknowledged by the trainee as being of distinct value, translating into changes in practice, particularly in terms of addressing power imbalances, enhancing communication with patients, supporting recovery and enabling supported decision-making. The main barrier to implementation of such changes was identified as being the lack of support of senior clinicians. The active support and enablement of trainees who want to share and apply new perspectives, models and approaches being advocated, including through current training, would likely be of benefit to all.

Psychotic disorders are central to mental health service provision and a common theme of academic research programmes in Ireland, which explore the neurobiological and psychosocial risk factors underpinning the development and progression of these illnesses. While we await the discovery of novel pharmacological treatment targets for psychotic disorders, it is important to employ our existing management strategies to optimal effect. In this special issue on psychosis, a selection of clinical research studies and reviews from Irish researchers, and often of Irish populations, are brought together which span the trajectory of psychotic illness from early intervention to treatment resistance. The topics include the characteristics and course of first episode psychosis cohorts, real-world evaluation of early intervention services, management strategies for treatment resistant schizophrenia and neurobiological research into social stress. The current editorial provides an overview of these papers and highlights the initial steps of the Irish Psychosis Research Network towards developing an integrated clinical research network focusing on the treatment and research into psychotic disorders.

This article focuses on the development of Ireland’s first National Student Mental Health and Suicide Prevention Framework for Higher Education. There is growing concern for student mental health in higher education nationally and globally. The majority of students are aged between 18 and 24, which is identified as a high-risk group for mental health difficulties. Recent surveys of student mental illness, mental distress, and low well-being have been recognized by the World Health Organization, the Union of Students in Ireland National Report on Student Mental Health in Third Level Education, the My World survey and the My World 2 study. The Higher Education Authority in Ireland made a commitment to the Department of Health Connecting for Life (Ireland’s National Strategy to Reduce Suicide 2015–2020) to form national guidelines for suicide prevention in higher education. In order to deliver on this commitment, The National Student Mental Health and Suicide Prevention Framework was developed. The Framework is informed by international evidence and was the product of a collaborative cross sector and cross disciplinary team including health professionals, government representatives, educators, students, policy makers, community organizations, researchers and clinicians.

The adverse effects of marijuana are well documented, as well as its positive therapeutic uses. Cannabis has traditionally been associated with an antiemetic action following acute ingestion and synthetic cannabinoids have an established use as antiemetics for chemotherapy induced nausea. However, there has been limited recognition of chronic cannabis use as a cause of cyclic vomiting syndrome. Cannabinoid hyperemesis was first identified by Allen er al in 2004. Compulsive bathing was also described as part of the clinical picture. This same syndrome has been confirmed a number of times in the medical literature in the interim. The condition has, to our knowledge, never been reported, in a psychiatric patient.

Objectives: Psychological services to patients with cancer are very limited in Ireland. A dedicated psycho-oncology service was established at our Institution 18 months ago. The aim of this study was to examine referral rates, psychiatric diagnoses and treatment interventions in this patient group.

Methods: The clinical and psychiatric characteristics of consecutive patients (n = 63) referred to a recently established specialist psycho-oncology service in an Irish university teaching hospital over a one-year period were examined prospectively. International diagnostic criteria were applied. Forms of treatment instituted and clinical response to same were also audited.

Results: Over half (54%) of patients presented with affective disorder spectrum illnesses. The remaining referrals represented a diverse group of psychiatric diagnoses, but included a large proportion of patients with delirium. Approximately 20% of patients did not meet criteria for a psychiatric diagnosis. There was an over-representation of breast cancer and lymphoma. Thirty-eight per cent of patients were on prescribed corticosteroids at the time of referral. Eighty-two per cent of patients required some form of psychiatric intervention, and 86% of these benefited clinically from our intervention.

Conclusions: The data suggest that even in oncology services with good existing support networks, such as this one, the role of an additional input from liaison psychiatry is considerable.

Functional neuroimaging is playing an increasing role in psychiatry and has moved from academic isolation into clinical practice. This review examines the basis for the use of Single Photon Emission Computed Tomography, the most widely available functional modality, in the two important areas of dementia and parkinsonism. Its contribution to the diagnosis and management of patients is discussed and its likely impact in clinical trials indicated. As functional imaging moves closer to those most able to utilise its power its impact in these and other areas of psychiatry and neurology will increase further.

Welcome to the third module in our Continuing Professional Development Section (CPD). CPD is now a key element in the clinical activity of all health professionals and a cornerstone of good clinical governance throughout mental health services. This section of the Irish Journal of Psychological Medicine will provide CPD modules dedicated to key topics in mental health care. In order to assist learning and self-assessment, multiple choice questions will be provided at the end of each module.

This module and its multiple choice questions are available online on the website of the Irish Journal of Psychological Medicine (www.ijpm.org). The CPD policy of the College of Psychiatry of Ireland indicates that psychiatrists who participate in suitable online learning which fits the criteria for CPD may claim CPD points under the Personal CPD category (up to a maximum of 5 points per year).

We are confident that this CPD Section of the Irish Journal of Psychological Medicine will prove to be a valuable resource for consultant psychiatrists, psychiatric trainees and all journal readers. We welcome feedback from readers and, especially, any suggestions for topics to be covered in future CPD modules. Suggestions should be emailed to: [email protected]