In this time of Covid-19, life in healthcare has changed immeasurably. It has rapidly been injected with an ‘all hands-on deck’ approach, to facilitate the necessary adaptations required to reduce the spread of the virus and deliver frontline clinical care. Inevitably aspects of these changes have disrupted the delivery of medical education, notably clinical placements have been cancelled and social distancing guidelines prohibit face-to-face teaching. The training of future doctors is an essential part of this effort. Indeed, the emergence of a global health threat has underlined its continued importance. For medical educators and students alike, we have been presented with a challenge. Concurrently, this presents us with an impetus and opportunity for innovation. For some time now, a transformation in medical education has been called for, with an increasing recognition of the need to prepare students for the changing landscape of healthcare systems. This has included a focus on the use of technology-enhanced and self-directed learning. As a team of educators and clinicians in psychiatry, working in the School of Medicine and Medical Sciences (SMMS) in University College Dublin (UCD), we will share how we have responded. We outline the adaptations made to our ‘Psychiatry’ module and consider the influence this may have on its future delivery. These changes were informed by direct student input.

Objective: A descriptive survey of the characteristics of medical and surgical patients given the diagnosis of adjustment disorder.

Method: 124 case notes of patients with adjustment disorder diagnoses seen over a one year period in a tertiary care hospital were reviewed to describe their characteristics. Patient demographic data, medical illness, hospitalisation details and psychiatric consultation notes were examined.

Results: This diagnosis represented 18.5% of consultation-liaison referrals. The length of hospitalisation for the adjustment disorder patients was more than twice that of general medical admissions. At least one psychosocial stressor was noted in 93% of all patients; in 59% of patients the medical illness was one of the stressors noted. About a third of patients had a past psychiatric history. Only 9% of patients had new courses of antidepressants recommended and in only 2% was inpatient psychiatric admission required. The diagnosis was used especially in patients with serious medical conditions, self-harm, injury and poisoning, and in cases presenting with a mixture of somatic and psychic symptoms.

Conclusions: The results suggest that this is a commonly used diagnosis in the medical consultation setting; it is largely being used in a way consistent with DSM criteria, whilst there were indications that it was also used for a range of problem behaviours that are difficult to classify.

Objectives: To establish the prevalence of psychological problems in older adolescents.

Method: The Youth Self Report was completed by teenagers in a class group. Percentages scoring above clinical threshold were calculated. Gender differences and variances between school type were examined.

Results: Seven hundred and seventy-nine students participated in the study, 373 males and 406 females. Of the girls 23% reported problems in the clinical range on total problem score compared with 19% of boys. Significant gender differences were noted on total problem and internalising scores but not on externalising scores. The levels of psychological problems did not appear to be influenced by school type. Of the total group 6.4% reported thinking of suicide frequently (almost twice as many girls as boys) and this rose to 25% of girls who scored in the clinical range of total problem score and 15% of boys.

Conclusions: Twenty-one per cent of adolescents had problems in the clinical range. Girls reported more problems than boys. It was surprising to find that there was no gender difference in reported levels of externalising problems. The high expression of suicidal and thoughts of self-harm in those with externalising and internalising problems is of concern. This highlights the vulnerability of older adolescents as they tend to fall between the current child and adolescent services. Service provision for this population should be a priority in rural areas and on a national basis.

Objectives: To review the clinical presentation, and Accident and Emergency Department clinical response to 14-20 year olds in suicidal crisis in inner city Dublin and to carry out a six month follow up of these young people.

Method: A retrospective review of the case notes of all 14-20 year olds who had attended the Mater Hospital A&E department between June 2001 and May 2002 with suicidal behaviour or ideation was carried out in order to establish socio-demographic information, type of suicidal or self-harming behaviour, intervention in the A&E department, and discharge plan. Active outreach attempts were made to trace, contact and interview these young peoples at least six months after the initial presentation. Quantitative measures of psychological functioning at follow-up included the General Health Questionnaire, The Beck Depression Inventory and The Scale for Suicidal Ideation. A qualitative interview covered their recall of the reasons for their deliberate self harm, their view of their current psychological functioning and personal relationships, reported repetition of deliberate self harm, and their views of what type of services would be useful for young people with suicidal ideation or behaviour.

Results: A total of 89 young people aged 14-20 years (male: female ratio = 2:3) presented to the Mater A&E department between June 2001 and May 2002 with deliberate self-harm, deliberate self-poisoning and/or suicidal ideation, and accounted for 108 presentations. They showed high levels of psychosocial disadvantage. Almost half had a history of previous contact with mental health services, while the same proportion had a history of previous deliberate self-harm. Drug overdose using paracetamol was the most common method used. Psychiatric assessment was documented in 66% of cases, and documented follow up recommendations were made in 60% of cases. Two thirds of the 89 young people who formed the study population were traced. Half of those contacted agreed to be interviewed and half refused. The majority of those interviewed described themselves as functioning better psychologically than at the time of the index attendance at the A&E department The quantitative measures supported this. One third of those interviewed reported repeated deliberate self-harm since their index attendance, for which most did not seek medical intervention. Many of the young people had clear views about the importance of talking to someone when in crisis. They described a service, which was informal, accessible on a 24-hour basis, and staffed by people with experience of mental health, alcohol and drug related disorders.

Conclusions: This is a particularly vulnerable group of patients from a socio-demographic and mental health perspective. Their attendance at the A&E department provides a unique opportunity for an in-depth psychosocial assessment, which should be recorded in a systematic way to assist clinical audit, facilitate strategic mental health planning and may confer some therapeutic clinical benefit to at risk young people. An easily accessible, active DSH team specifically tailored for young people in the A&E department could provide assessment and short-term follow-up. This is the approach recommended by young people in suicidal crisis, whose views need to be heard.

Objective: Long waiting lists have a negative impact on client satisfaction, staff moral and referrer's opinion of the service. The aim of this project was to decrease a waiting list from a maximum wait of more than one year to a wait of no more than six weeks.

Method: We introduced three simultaneous initiatives to decrease a long waiting list; (i) an individually led triage system (ii) setting-up an attention deficit hyperactivity disorder (ADHD) specialist team and (iii) division of the residual waiting list between team members. These initiatives were introduced and analysed over a ten month period. The study period ran from 1/3/2004 to 31/12/2004.

Results: The waiting time to first appointment was significantly reduced. At the beginning of the study there were 62 people waiting to be seen and each had waited an average of 122 days with a waiting time range of 0-449 days. At the end of the study, there were 19 people waiting with a mean waiting time of 19 days and a range of 0-168 days.

Conclusions: The single most powerful intervention was the triage system. The ADHD clinic allowed referrals to be streamlined in a very structured and efficient way. The division of the residual waiting list was not as onerous as it first appeared. The service saw more referrals then ever during the study period. Referrers and families appreciated being seen more quickly. By removing the burden of the waiting list from staff the potential for creative thinking around further development of the service increased.

Objective: This survey attempts to ascertain the attitude of the general public towards the mentally ill and former psychiatric patients in Ireland. Method: A random selection of 155 adults were interviewed using Likert-type scales (29 items). Results: Factor analysis revealed four main attitude dimensions: fear, lack of sympathy, personal rejection and perceived community rejection. Overall, respondents express a low level of fear and a high level of sympathy towards the mentally ill. Lack of sympathy correlated highly with older age group, lower educational level and lower socio-economic class of respondent. Respondents with higher self-reported knowledge about mental illness were less fearful and more sympathetic towards the mentally ill. Conclusions: The findings are encouraging to the development of community psychiatric services and support the usefulness of public education in the area of mental health.

Meditation is believed to have many health benefits apart from enhancing spiritual health. However, there is evidence that meditation may even lead to psychosis or worsen it in some cases. The aim of this paper is to present a case and discuss the role of meditation as a precipitating factor to psychosis. A 27-year-old male presented with psychotic symptoms with a temporal correlation with meditation. He was then successfully treated with antipsychotic medication and is maintaining well. This case report highlights the possibility that intense meditation could precipitate psychosis in vulnerable individuals. However, there are several beneficial effects of meditation in patients with psychosis if practiced with caution.

Objective: This study was carried out to determine the prevalence of selective mutism (SM) in an urban school population and to assess comorbidity and family characteristics.

Method: Teachers of primary schools, teaching children between the ages of four and 12, were sent a description of SM and asked to complete the selective mutism questionnaire (SMQ) if they believed a child in their class met criteria. Thirty-nine schools were sampled, covering a catchment area of 10,927 children. Children who screened positive on the SMQ were offered a full psychiatric assessment. Parent, child and clinicians completed various rating scales.

Results: A response rate of 100% from schools was obtained. The prevalence rate of SM was 0.18% (20/10927). fourteen (70%) attended for further evaluation. All children scored within the clinical range on the Clinical Global Assessment Scale (CGAS), indicating moderate to severe impairment. fifty percent (7) reported a family history of social anxiety disorder, and 43% (6) autistic spectrum disorders.

Conclusion: This is the first Irish based prevalence study of SM. Results indicate that SM is not as rare as previously believed. Children with SM were found to have significant functional impairment along with a strong family history of anxiety and autism.

Objectives: Parents often present practising clinicians who see children with chronic fatigue syndrome with printouts from the internet. These are then brought into the discussion about the management and aetiology of this debilitating condition. We set out to systematically study the information on the internet on this subject and to explore the diversity of advice in relation to current research knowledge.

Method: Systematic search by means of the internet browser Netscape Navigator and search engines AltaVista and Yahoo! Advice about levels of rest, exercise, medication, psychological interventions and suggestions about return to school is critically compared with current research evidence.

Results: Thirteen websites were accessed. All have some treatment advice. Six offer conflicting advice about levels of rest, with two suggesting large amounts of rest, two suggesting some rest and two suggesting graded exercise. Nine suggest medications (with a wide variety of pharmacological activities) despite the lack of research evidence showing a significant contribution from medication. Four suggest psychological treatments but some advise that it is unnecessary despite the established evidence in chronic fatigue (and other chronic illnesses) that appropriate psychological treatments are helpful. There are a wide variety of differing diets recommended.

Conclusions: Few websites provide useful management advice. Advice offered is often in conflict. Some of the advice is either contrary to current research evidence or not supported by it. This raises concerns about inaccurate information reaching families who have a child with chronic fatigue syndrome, with potentially damaging consequences. This suggests a need for a debate about the availability and validation of health related information on the internet.

The recent government health strategy document described the integration between primary and secondary care in Ireland as often poor and outlined plans to redress this deficit. In mental health care, the gradual shift away from institutions over the past four decades has resulted in the GP becoming the most frequent professional contact for people with mental disorders. However, access to specialist opinion is usually available only for the fraction of psychiatric presentations which are formally referred to the psychiatric service.

On-site psychiatric liaison to primary care is commonly practised in other countries but not in Ireland. Research in the area suggests possible advantages for approaches which aim to enhance GPs' psychiatric skills while selectively encouraging referral of more serious disorders. This model has been adopted by GPs and psychiatrists in east Cavan and may be relevant to other similar settings, especially in the context of forthcoming changes in the organisation of primary care services.

Objectives: People with intellectual disabilities are increasingly living in more domestic style accommodation, either in housing provided within a specialised campus setting or in ordinary houses in community settings. The main objective of the study was to determine if the extent of residents' involvement with their families and with the local community varied when they resided in campus settings (n = 55) or community housing (n = 51) and to investigate the main predictors of this involvement.

Method: With the resident's permission, their key-workers – mainly nurses – completed standard questionnaires that covered resident characteristics, contact with families and a range of life experiences.

Results: Although the type of accommodation did have a significant effect on residents' social inclusion in families and communities, the best predictor of this was the individual's level of dependency in personal self-care. Those who were more dependent tended to be more excluded.

Conclusions: Staff working with more dependent residents need to proactively promote their social inclusion although this could be harder to achieve for those living in campus style settings.

In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.