Objectives: This study examined the prevalence of depressive symptoms, including suicidal ideation/behaviour, among bullied and non-bullied young people.

Methods: Participants were 209 students, 97 male and 112 female, attending eight urban post-primary schools and aged between 12 and 15 years. Participants were interviewed using the Schedule for Affective Disorders and Schizophrenia for School Aged Children – Present and Lifetime Version, the Hopelessness Scale for Children, the Scale for Suicide Ideation, and the Suicide Intent Scale.

Results: Data were analysed using a series of non-parametric comparison tests. Being a victim of bullying was found to be significantly associated with depression (χ2 = 10.986; df = 1; p = 0.001) and suicidal ideation (χ2 = 5.811; df = 1; p = 0.022). Results also indicated that victims were more likely to have reported a suicide attempt (χ2 = 5.995; df = 1; p = 0.022). Finally, those bullied were significantly more likely to have been referred to psychiatric services (χ2 = 6.661; df = 1;p = 0.011).

Conclusions: These findings suggest that the issue of bullying needs to be re-addressed within Irish schools, with particular emphasis placed on further investigation into the psychological consequences thereof.

Objectives: Suicide is now the commonest cause of death among young Irish males. The literature identifies a wide range of contributory risk factors in suicide. However, a number of realities have frustrated clinicians' efforts in the area, including the reluctance of young males to engage in mental health services. In this study, we sought to explore the problems experienced by young men in a rural setting and their attitudes towards seeking help.

Methods: Focus groups were employed to generate themes for a qualitative and quantitative questionnaire which was administered to a community sample of 71 young men (22.4% of the total number of males aged 16-30 years in the area) and 79 key informants. The questionnaires contained demographic items and examined available social outlets, types and extent of difficulties experienced by young men and perceptions of and access to potential sources of support.

Results: Both young men and key informants reported that peer pressure and alcohol misuse are areas of most difficulty, that friends and family are the preferred sources of support and that young men view much existing professional help as unacceptable.

Conclusions: This study provides a basis for the next stage in the research cycle and also supports the viability of building a partnership between the health services and the local community in developing future suicide prevention strategies for young men.

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.

Background: There is no published research on attitudes of psychiatrists towards children visiting parents who are acutely-unwell and inpatients in psychiatric hospitals. Nor is there information on facilities available for such visits.

Objectives: (I) To assess the attitudes of Irish psychiatrists towards children visiting. (II) To determine the availability of child-friendly facilities within admission units.

Method: A questionnaire was posted to every consultant psychiatrist accepting acute adult admissions in the Republic of Ireland and Northern Ireland.

Results: The response rate was 69%. Ninty-seven per cent were in favour of children visiting. Almost half felt that decisions on visits should depend on the particular situation, considering the child, parent, ward, etc. However, only 11% of units had a room/area designated for children visiting. 90% had no facilities they considered child-friendly on their unit. A majority felt that arrangements for children visiting were inadequate.

Conclusions: This topic is of interest to psychiatrists, and can be contentious, particularly when considering supervision of, and legal responsibility for, children visiting. Guidance on these issues would aid psychiatrists and hospital management. Poor facilities and infrequent visits may be a factor in the early development of stigma towards mental illness. Further research, improvements in facilities and staff training in liaison with children are needed.

Objectives: To establish the prevalence of postnatal depression using standardised methods of diagnosis and to evaluate early detection of postnatal depression.

Methods: Prospective cohort study. Prevalence established using two-step screening with EPDS and semi-structured clinical interview for ICD-10 diagnosis. EPDS recorded at day three-five postnatal evaluated as predictor of depression at week six postnatal.

Results: Prevalence established at 14.4%. EPDS recorded at day three-five postnatal when combined with past history of depression was a predictor of depression occurring at week six postnatal.

Conclusions: We found a similar prevalence of postnatal depression in this Irish sample to other international prevalence studies. There are implications for hospital based screening to identify those at risk of developing a postnatal depression.

Objectives: There is a view that antipsychotic drugs can be successfully withdrawn from people with intellectual disabilities with resultant health gain. This study critically examines whether antipsychotic drug withdrawal is beneficial.

Methods: 119 adults with intellectual disabilities were included in a programme of antipsychotic drug withdrawal.

Results: The clinical outcomes of this programme are poor. Only 7.6% completely withdrew from antipsychotic drugs, and 48.7% experienced onset/deterioration in problem behaviours or mental ill-health. Significant drug side effects with the introduction of new drugs were experienced by 23.3%. Resultant mean antipsychotic drug doses were higher compared with those at the start of the programme. The cost to the intellectual disabilities psychiatric service (over and above that of routine psychiatric care) was £258,050 (€391,693), and the human cost was considered high. Primary care, social care and family costs were not calculated. The only specific factors found to be associated with poor outcome were increased severity of intellectual disabilities and female gender.

Conclusions: The successful role of antipsychotic drugs in the management of problem behaviours in people who do not have verbal communication skills may relate to the pathoplastic effect of intellectual disabilities on clinical presentation, with problem behaviours being markers of eg. psychosis and anxiety disorders. Our original findings challenge the view that routine withdrawal of antipsychotic drugs is good practice; we reinterpret the existing literature, and recommend caution and vigilance in pharmacotherapy.

Objectives: To examine the prevalence and persistence of psychological problems in older adolescents.

Methods: This study is a one year follow-up of 110 adolescents, 64 girls and 46 boys attending three secondary schools in Ireland. All were 16 at initial testing. The Youth Self Report (YSR) was the measure used.

Results: Over a fifth of adolescents have problems in the clinical range. These problems persisted from 16 to 17. Females reported more problems than males at both ages. Some females showed a slight reduction in internalising problems at 17. Both males and females showed an increase in externalising problems at 17. Odds ratios indicate that those in the clinical ranges of the YSR at 16, had increased risk of being in the clinical range at 17 compared to those in the no problem range at 16. In comparison to those with no suicidal feeling, those with suicidal feelings at 16 were at an increased risk of still feeling suicidal at 17. More males remained psychologically healthy than girls.

Conclusions: A large proportion of adolescents in this sample have psychological problems and these appear to persist over a one year period. These problems impact substantially on the adolescents themselves, their families and society. Given the increasing suicide rate in young people and the persistence of suicidal feelings in this cohort, the inadequacy of mental health services in Ireland for adolescents, particularly those ages 16-18 is highlighted. The challenge of developing and providing adolescent friendly services is addressed.

Objectives: To investigate the relationship between psychiatric symptoms, personality disturbance, and social function.

Method: Longitudinal study of 100 psychiatric patients presenting as emergencies originally entered to a randomised trial of community and hospital-based treatment strategies. Ratings of social function using the Social Functioning Questionnaire, personality status using the Personality Assessment Schedule, and clinical symptomatology using the Comprehensive Psycho-pathological Rating Scale were recorded at baseline with assessment of social function repeated at two, four and 12 weeks. Correlation, regression, and path analysis were performed to test the hypothesis that personality status had more influence than clinical symptoms on social function.

Results: Path and regression analysis showed, that at baseline both psychopathology and personality pathology contributed to social dysfunction equally, but from two weeks onwards personality abnormality contributed to a greater degree than clinical psychopathology. Of the 100, 35 patients had a personality disorder and in these there was a strong correlation between social function scores at baseline and 12 weeks (48% of variation explained) whereas in those with no personality disorder the correlation was much weaker (14%); regression analyses confirmed this conclusion.

Conclusions: Psychopathology and personality status contribute to social dysfunction in patients presenting as emergencies but persistent social dysfunction is more likely to reflect personality pathology than other forms of mental disorder.

Objectives: This study was designed to test a proposed relationship between the total impact score (devised by the authors) and the quantum of damages in compensation received by victims of criminal and political violence. In so doing, the authors sought to develop a mathematical formula which could be used to quantify damages in a simple and expeditious manner.

Method: Data on 2,191 victims of violence was collated forming three databases of information, on the incident, on the victim and on the outcomes. A tool of measurement of the psychosocial impact of the traumatic event was designed (the Total Impact Score). Information on a subsample of the 208 survivors of attempted assassination was then selected and the TIS for each individual was calculated and examined for correlations with other variables including the quantum damages awarded.

Results: The TIS was shown to have validity as a measure of the psychosocial impact of a traumatic event upon an individual. The analysis showed a significant relationship between the TIS and quantum awarded. This relationship was used to generate a mathematical formula which could be used to calculate quantum damages in any case. Compensation = £500 × (10(0037t+0.059y) -1), where t is the TIS and y is the number of years after 1985.

Conclusions: The TIS can be taken as a valid tool for quantifying the psychosocial impact of a traumatic event or violent act. The tool consists of a checklist of readily ascertainable outcome variables each of which can be scored and a TIS calculated. From this score the amount of damages can be ascertained. The authors believe that this measurement tool represents a fair and equitable method of calculating a case's worth.

Objectives: Medication non-adherence in affective disorder is an area of concern. Abbreviated cognitive therapy for adherence (ACTA) is an intervention specifically designed to address this. Our objectives were to explore psychiatric trainees' experiences of delivering this therapy, and to examine patient satisfaction using the Client Satisfaction Questionnaire (CSQ).

Method: This preliminary study took place in two centres in Scotland. The experiences of five higher psychiatric trainees who underwent training in this novel approach were gathered at a ‘brain storming’ meeting after completing training, which included clinical application of the intervention. Also included is the preliminary feedback from a small number of participants involved in a randomised controlled pilot study of ACTA provided by these same trainees. In this pilot, 15 participants with bipolar affective disorder were allocated to receive ACTA (n = 7) or treatment as usual (TAU) (n = 8) and both groups completed a CSQ (client satisfaction questionnaire) at the end of the study.

Results: It was possible to learn and use this approach with limited previous experience of cognitive behavioural techniques. Longer structured sessions with the patients fostered the development of a collaborative relationship and facilitated negotiation of a treatment plan. There was 100% attendance rate for those receiving ACTA. Satisfaction scores for both the ACTA group and TAU group were high with median scores greater than 55 from a maximum of 60 in both groups. The ACTA group made additional positive comments.

Conclusions: Training in a brief therapy, such as ACTA, appears possible during psychiatric training and may represent a useful set of cognitive and behavioural techniques for busy clinicians. Preliminary findings suggest that patients like it.

Objectives: This study assessed self-reported prospective memory and related central executive processes in a group of excessive alcohol users and non-users. The aim was to assess whether excessive alcohol use is associated with impairments in these two sets of memory processes.

Methods: Eighty participants from the North-East of England were tested. Of these, 40 were excessive alcohol users (using above the recommended weekly ‘safe’ dose of alcohol) and 40 were low-dose/non-users. Each participant was assessed using self-reports of prospective memory (PM) – measured using the Prospective Memory Questionnaire (PMQ) and central executive (CE) processes – measured using the Dysexecutive Questionnaire (DEX). Other drug use, age and strategy use were incorporated into the study as controls.

Results: After controlling for other drug use, age, and strategy use, excessive alcohol users reported global impairments in everyday prospective memory and in their central executive processes, when compared to a low-dose/no-alcohol control group.

Conclusions: These findings suggest that excessive alcohol use has a detrimental impact upon everyday memory – a relatively unexplored area of research. PM and CE deficits should be added to the growing list of neuropsychological sequelae associated with chronic excessive alcohol use.

Objectives: Agraphia is the loss or impairment of the ability to produce written language as a consequence of brain damage and is a well recognised feature of dementia. However there is no generally accepted classification of agraphic disorders. Our aim was to determine the influence of writing style, lettercase and sentence polarity of the writing component of Folstein's MMSE on the overall test score.

Methods: We retrospectively reviewed the ‘write a sentence’ request of Folstein's MMSE of 280 randomly selected patients attending a geriatric day hospital. We analysed four sentence characteristics: 1 Number of words, 2 Writing legibility, 3 Sentence polarity, 4 Letter case.

Results: 280 MMSE forms were examined, 165 were from female patients. Mean age was 81.7(± 6.6) years. Mean MMSE score was 21.6 (males: 21.9, females: 21.4). Significant correlation was detected between the overall MMSE score and both legibility and number of words. Legibility scores were significantly higher for females than for males (7.2 vs. 6.6, p < 0.03). The mean MMSE of females writing in lowercase was significantly higher than for those writing in uppercase (21.5 vs. 18.6, p < 0.05). The mean MMSE score of subjects writing sentences with a positive tone was significantly higher than that of those writing a neutral or negative sentence (22.6 vs. 21.0 p < 0.03).

Conclusions: We have demonstrated a relationship between the content and structure of the writing assessment aspect of the MMSE and the overall test score.

Objectives: This paper aimed to examine the outcome of hostel treatment including the effect on hospitalisation rates.

Methods: The work of the four medium/long term Gloucester hostels developed between 1983 and 1993, to provide 24-hour nursed care to ‘new long stay’ patients in Gloucester is described.

Results: Fifty-eight patients with predominately severe mental illness were admitted to the hostels up to 1999, and demographic/illness data is presented. Mean duration of hostel stay was 4.8 years, and one third of patients were readmitted to hospital (most briefly) during their hostel admission, one patient 11 times. Thirty-four patients were discharged from hostels, 29 to less dependent settings, but four referred to hospital care. There was a significant reduction in the number of admissions and duration of hospitalisation in the time between discharge from the hostel to the present or death, as compared with the same time frame for each individual prior to entering the hostel system.

Conclusions: The data adds further support to the potential value of 24 hour nursed care for patients with severe mental illness.

Objectives: We sought to determine whether elderly bereaved patients attending an old-age psychiatry service were more likely to have been bereaved through suicide than through other causes.

Methods: We studied the demographic and clinical profiles of all patients attending an old-age psychiatry service who had experienced the death of an adult child. We compared the causes of the deaths of their children with the most recent figures for the national population.

Results: Deaths from suicide among the children of the bereaved elderly were commoner than for the age-matched national population.

Conclusions: Suicide is more likely than other causes of death to lead to psychiatric morbidity in elderly parents. The needs of elderly survivors should be considered in formulating national strategies for suicide prevention. Further studies are needed on risk factors for complicated bereavement in the elderly.