Objectives: To investigate effects on one psychiatric inpatient service of a 40% reduction in the number of acute beds and the establishment of an acute day hospital.

Method: A retrospective review of all public admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of attendance at the acute day hospital during the second study period.

Results: The number of admissions actually increased by 3% from 169-174; the mean duration of stay fell from 27-17 days; and the number of brief admissions of three days duration or less almost tripled from 15-43. Although fewer patients suffering from schizophrenia were admitted in the second study period than in the first, their mean duration of stay and the frequency of re-admission within 28 days of discharge changed little, while patients with diagnoses of mild/moderate depression and substance misuse experienced significantly shorter admissions and higher readmission rates. The use of temporary orders under the Mental Treatment Act (1945) doubled, and the readmission rates within 28 days increased by over 60%.

The acute day hospital treated 98 patients who had a diagnostic profile similar to that of the inpatients; 53% of them required admission before and/or after attendance at the day hospital.

Conclusions: The major reduction in the number of acute inpatient beds and the opening of an acute day hospital resulted in greater concentration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in admissions and may have a complex aetiology and merits further investigation.

Objectives: To identify the number of cases, and hence the prevalence of, early onset dementia within a defined catchment area in Dublin. To identify the associated clinical characteristics of those identified, and to measure service use and carer burden.

Method: A comprehensive case finding study was carried out, and all those identified were contacted and sufferers and carers were interviewed using both standardised and semi-structured questionnaires.

Results: Twelve cases were identified, yielding a prevalence rate of 45/100,000 in the 45-64 year age group. Sufferers exhibited a high level of cognitive impairment and associated psychiatric and behavioural symptoms, and carers exhibited a high level of stress, especially those still actively caring. Service provision for this group was patchy and did not tally with their level of dependency.

Conclusions: Recommendations are made for appropriate provision of services for dementia sufferers, regardless of age.

Objectives: To audit the incidence of a history of childhood sexual abuse (CSA) in women with diagnoses of drug and alcohol misuse disorders.

Method: A definition of CSA encompassing the US National Centre on Child Abuse and Neglect's definition of child sexual abuse was used. In the six month period of audit details of CSA were recorded from clinical data for all consecutive female new patients (n = 49) of the substance misuse service in St. Luke's Hospital, Armagh.

Results: Of the 49 new patients, information on childhood sexual abuse was available for 44 subjects. Sixteen (36.36%) of 44 had a positive history of CSA.

In 13 (81.25%) abuse occurred before the age of 16 years. Sexual intercourse was described by 50% and sexual contact by 50%. Only one patient had reported CSA to the police and only one patient had received counselling. There was a difference noted in the addiction profile of those with a history of CSA, 44% of this group had either alcohol dependence syndrome/harmful use of alcohol compared with 66% of the non-CSA group. The perpetrators were all male.

Conclusions: Our audit confirmed other work which showed a high incidence of childhood sexual abuse histories in addicted women. This is one of the areas which may not be properly addressed by conventional addiction treatment programmes, which are male centred and male dominated. It adds to the growing body of evidence that suggests adaptations must be made as increasing numbers of women present for addiction problems.

This article reviews the current knowledge regarding the hepatic cytochrome P450 system, with particular reference to its effect on psychotherapeutic medication. The metabolic processes – by which drugs are broken down in the liver by cytochrome P450 enzymes – are affected by genetic variation between individuals, inhibition and induction of these enzymes by other drugs, disease and age. Genetic influences and enzyme inhibition/induction are discussed in particular detail in this article.

A period of psychiatric training in New Zealand is relatively easy to organise and provides opportunities not available locally. This article illustrates some of the similarities and differences between Irish and New Zealand psychiatry and provides advice on how to arrange a placement.

A case of self-inflicted eye injury is described in a setting of alcohol intoxication and severe personality disturbance. The case is believed to be the only one of its type described this century. The relevant classical and contemporary literature is reviewed and psychopathological explanations discussed. Possible indicators of impending self-violence are reviewed.