Montelukast (a leukotriene receptor antagonist) is a commonly prescribed medication used in the management of asthma in both children and adults. It has been associated with a possible increased risk of various neuropsychiatric events in post-marketing analyses of clinical trial data and surveillance studies. When establishing a link between a medication and side effects, it is usual to establish and enquire whether there is a chronological relationship between the commencement of the medication and the onset of the symptoms.

We report a case where a number of unusual neuropsychiatric events were reported several years after commencement of montelukast in a young boy who may have a genetic predisposition and a likely psychological trigger. There was complete resolution of these symptoms upon the withdrawal of montelukast.

The Richmond Asylum (St Brendan's Hospital) in Grangegorman, Dublin was established in 1815 to help address the unmet needs of the mentally ill in 19th century Ireland. This paper examines the Richmond Asylum Joint Committee Minutes from 1907 in order to explore specific aspects of management and clinical activity at the Richmond Asylum, including: (a) patient populations in the asylums; (b) staffing and management issues; (c) challenges presented by workhouse populations in the early 20th century; and (d) the clinical ‘segregation’ of patients performed by the Medical Superintendent, Dr Conolly Norman, in 1907.

Suicide is recognised as the most devastating possible outcome of a schizophrenic illness. This study examined the characteristics of 15 schizophrenic patients who committed suicide. These patients were older and less socially isolated than noted in other research. Drowning was the commonest method of suicide and overall, the methods chosen were comparable to those reported among the general Irish population. A past history of deliberate self harm was common although no temporal relationship between such behaviour and suicide emerged. The findings are discussed in the light of the existing literature on this topic.

Objective: To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group.

Methods: All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist.

Results: A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group.

Conclusions: Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.

The history of psychiatry is the history of therapeutic enthusiasm with all of the triumph and tragedy, hubris and humility that this brings. As a result, the emergence of any new diagnosis, such as attention-deficit hyperactivity disorder (ADHD), needs to be greeted with caution, rigour and scientific objectivity, as well as compassion, therapeutic engagement and optimism. Although there is now little doubt that ADHD is a valid, useful diagnostic concept, and progress has been made, there is still considerable work to be done to establish its incidence, prevalence and biological underpinnings, as well as optimal therapeutic strategies. As with all mental illnesses, it is likely that knowledge will develop over many decades and diagnostic criteria will be refined in parallel. In the absence of definitive biological understanding, there should be particular caution about over-exuberant diagnostic expansionism unless it is accompanied by compelling evidence of therapeutic benefit for those diagnosed.

Individuals’ mental health and wellbeing are dependent on many social factors including housing, employment, education and adequate nutrition among others. These factors can influence at personal, family and community levels. The interlinked and cumulative impact of these social determinants needs to be ascertained to aid appropriate patient management, as well as to establish prevention and health education programmes. Some of these determinants also have to be recognised at policy level. It is crucial for clinicians to understand the role social determinants play in the genesis and perpetuation of mental and physical illnesses, so that appropriate social interventions can be set in place. Clinicians have a role to play in their clinical practice, as well as advocates for their patients and policy leaders. In order to ensure that health is joined up with other sectors, such as education, employment, judiciary and housing, policy-makers must avoid silos. Every policy must have an impact assessment on physical health and mental health. Policy-makers need to understand scientific evidence and must work with researchers, clinicians, communities and patients to help develop and implement rights-based policies.

Background: Evidence from regions where there have been severe dietary restriction suggests that individuals in utero during periods of starvation may subsequently be at increased risk of schizophrenia. Because Ireland was the location of a major nineteenth century famine an attempt has been made to determine whether any such evidence for famine/schizophrenia association can be found.

Method: The data used derive mainly from the Annual Reports on the District, Criminal and Private Lunatic Asylums supplied by the Inspectors of Lunacy in Ireland for the relevant years. Nineteenth century diagnostic labels have been adjusted to conform to schizophrenia as currently understood. Evidence relating to a possible schizophrenia increase in famine-related emigrants is examined.

Results: There was an increase in first admission rates for schizophrenia of 85.7% from 1860 to 1875. Admissions for other disorders, chiefly melancholia, also increased. Similar admission increases were evident in other jurisdictions over the same period. Data relating to the mental health of famine – migrating Irish are sparse and of difficult interpretation.

Conclusion: The evidence from available data sources attempting to link the Irish famines of the 1840s with a subsequent increase in the incidence of schizophrenia is equivocal and inconclusive.

Exposure to traumatic experiences in childhood is a risk (and potentially causal) factor for the development of a range of adverse physical and mental health conditions. In addition to the onset of clinical disorders, there is emerging evidence that childhood trauma may also be associated with other long-term outcomes, such as the persistence and severity of an individual’s symptoms, as well as their long-term social and occupational functioning. However, the reasons for this remain poorly understood. A greater understanding both of the mediators that drive these associations, and those variables that enhance resilience against such damaging experiences may help to inform effective therapeutic interventions. In addition to biological and cognitive measures, there is a need to consider social and environmental factors, such as parental bonding and attachment, when investigating these complex relationships.

Benzylpiperazine is a psychotropic compound that has been widely available until recently from licensed premises such as ‘head shops’. This report describes a case of a 48 year old man with schizophrenia who developed an acute delirium secondary to benzylpiperazine use, although he initially presented as a diagnostic conundrum. Investigation of his delirium unearthed a temporal meningioma which appears to be an incidental finding. This is the first documented case of delirium due to benzylpiperazine use. Benzylpiperazine has significant abuse potential and psychiatric complications. Its sale and possession have recently been made illegal in Ireland, which may limit its abuse in the future.

Objectives: To provide normative data for older national (primary) school children, broken down by age and gender, for the Children's Depression Inventory-Short version (CDI-S) and revised norms for the Children's Depression Inventory-Parent version (CDI-P) and its subscales.

Method: Forty-three randomly selected national schools took part in this study. Participants were 1,255, fifth and sixth class, Irish national school children who completed the Children's Depression Inventory Short Form (CDI-S). In total 1,018 parents completed the corresponding parent form, the Children's Depression Inventory-Parent version (CDI-P).

Results: Norms for the CDI-S and the CDI-P subscales were produced. Revised norms for the CDI-P are proposed. Results revealed no significant age or gender difference in depressive symptomatology as measured by respondent's CDI-S and total CDI-P scores. Parent's ratings of their children's depression levels (CDI-P) and children's self-reported depression levels (CDI-S) were significantly correlated. The CDI-S and CDI-P displayed good internal reliability.

Conclusion: Results indicate the utility of both the CDI-S and the CDI-P for assessing depressive symptoms in national school children in Ireland. This study confirms that national school children do display symptoms of depression. School based policies, materials and services supporting and promoting positive mental health should be developed, implemented and resourced.

Objectives: To examine baseline testing and ongoing monitoring of cardiovascular and other risk factors in individuals prescribed atypical antipsychotic medications.

Methods: We derived a list of baseline and ongoing monitoring tests from the literature (Weight, BMI, blood pressure, U&E, LFTs, glucose, HbA1C, FBC, TFTs, prolactin, lipids & ECG) and then reviewed a random sample of 80 records of patients prescribed atypical antipsychotics and currently attending an Irish public catchment area service, for evidence of testing.

Results: Levels of testing for baseline tests ranged from 45% for blood pressure to 0% for BMI. Levels of ongoing monitoring tests ranged from 42.5% for U&E to 0% for BMI. Patients admitted to hospital were much more likely to have had testing.

Conclusions: The need for baseline and ongoing monitoring of certain tests in patients prescribed atypical antipsychotics is increasingly accepted. Levels of such testing are currently quite low and need to increase.

Objectives: Changes in healthcare policy over the last decade emphasise care in the community over residential care. Self-help organisations may play a useful role in these circumstances. Against this background, the objective of this study was to obtain the views of members of the main mental health professions on the place of self-help groups in mental health care.

Method: A postal survey of 255 mental health professionals from two health boards was carried out, using a semi-structured questionnaire that contained both open and closed questions. The responses obtained were analysed using descriptive statistics and content analysis as appropriate.

Results: The response rate was 35% so results must be interpreted cautiously. Self-help groups are used particularly in the management of addictive behaviours, and are also considered useful in cases of mood disorder. In general, self-help organisations are seen as providing support to patients and their families; information on mental illness/health to the general public; and lobbying for services relevant to the needs of their members. Respondents were concerned that the philosophy and programme of a group should not conflict with established models of mental health. The impact of the organisational structure of the multi-disciplinary team on the referral pattern of the different mental health professions, and the role of group availability and accessibility on the decision to refer a patient to a self-help group is commented upon.

Conclusions: While some professionals see a role for self-help organisations in the mental health care system, reservations expressed about a possible clash between selfhelp groups' approach and professional mental healthcare practice need to be addressed so that the potential of both positions can be realised.

Objective: The aim of this paper was to elucidate factors associated with inpatient suicide.

Method: A retrospective review of inpatient suicides over a 20 year period in the Cavan/Monaghan mental health service was undertaken. Clinical files, statutory reports and Central Statistics Office returns were studied and information was obtained on demography, diagnosis and circumstances of the event.

Results: Eight patients committed suicide, giving a rate of 0.55/1,000 discharges and 0.39/100,000 population per year. Depressive illness and Schizophrenia were the diagnoses found. Repeated admissions and long duration of illness were noted. Previous suicidal behaviour was common. Four of the patients were considered a suicide risk at some time during the index admission. Underreporting of the suicides and inaccurate registration of institutional location by the Central Statistics Office were found.

Conclusion: More formal clinical procedures in registering suicide risk are recommended. New procedures for investigating inpatient suicides are suggested. Largescale studies at a national level are essential in defining more specific and sensitive risk factors. Procedural changes involving accurate central registration of data are required.

Objective: To ascertain the views of Irish GPs with regard to local child psychiatry provision.

Method: 180 randomly selected general practitioners were sent a questionnaire designed to ascertain their views on child psychiatry services. They were asked to rate service provisions, professional staff and therapies offered in terms of priority.

Results: 74 (41%) returned completed questionnaires. Written reports, short waiting list times and emergency inpatient provisions were accorded the highest priority by the largest number of GPs (77%, 64.9%, and 63.5% respectively). Expertise in child sexual abuse, mental handicap and alcohol/drug addiction were also prioritised (77%, 66.2%, & 58.1% respectively). The core staffing required included child psychiatrists, community psychiatry nurses, psychologists and social workers. Family therapy followed by counselling were the most popular treatment modalities. However, more than two thirds (68.6%) of the sample rated their current service as unsatisfactory.

Conclusion: In planning service provision it is important to take into account the needs of the community, referrers' views and accessibility in order to provide optimum services for both users and referrers.

Objectives: To investigate the nature and pattern of teenage admissions (13-18yrs) to the 14 adult psychiatric units in Northern Ireland (NI) between 1989 and 1995.

Method: An analysis of routine hospital data, a review of case-notes at one hospital and in-depth interviews with young people previously admitted to adult inpatient care.

Results: Sixteen per cent of all under 25s admitted during the six-year period (443/2823) were under 18. There was an increasing trend over time in admissions and re-admissions to hospital. More than half of the teenagers were female and the most common diagnoses included emotional/conduct disorders, ‘stress’ and neurotic illnesses. Self-harm, substance abuse and exposure to violent/abusive environments or behaviour were the most commonly recorded factors preceding admission. All but one of the small number of people interviewed had attempted suicide prior to admission to hospital.

Conclusions: The increase in the use of adult inpatient care by young teenagers is of considerable concern but may be unavoidable in the absence of suitable alternatives especially for adolescents at risk of self-harm or suicide. Further research is required to determine the most appropriat e and effective service response for this vulnerable group . The findings have important implications for the future development of adolescent mental health services.

Objectives: There is a substantial knowledge gap about the distribution of mental health in community populations. The European Social Survey is particularly useful as it contains information on over 40,000 individuals, including 2,286 Irish adults. The objective of this study is to conduct a large scale statistical analysis to examine the distribution and determinants of mental wellbeing in a large representative sample of the Irish population.

Method: Analysis of the European Social Survey using robust multiple linear and non-linear regression techniques. The data-set contains WHO-Five scores and subjective wellbeing for a sample of 2,286 Irish people interviewed in their homes in 2005.

Results: Ireland has the second highest average WHO-Five score among the 22 countries in the European Social Survey. Multiple linear regression analysis across the distribution of WHO-Five reveals a wellbeing gradient largely related to education and social capital variables. A probit model examining the determinants of vulnerability to psychiatric morbidity reveals that a similar set of factors predict scores below the threshold point on the WHO-Five scale.

Conclusions: The results are consistent with marked differences in mental wellbeing across education levels and variables relating to social capital factors. Such indicators provide a useful index for policy-makers and researchers. However, much further work is needed to identify causal mechanisms generating observed differences in mental health across different socioeconomic groups.