Objective: The aim of this study was to determine the prevalence of metabolic syndrome and obesity as defined by Body Mass Index (BMI) in a long-stay psychiatric unit where all care is provided by the psychiatric team.

Method: All residents in this long-stay unit were screened. Their BMI was calculated. Waist circumference and blood investigations were done. Ward records were used to determine those who had been previously diagnosed with hypertension and diabetes. The ATP 111 criteria were used to determine the prevalence of metabolic syndrome.

Results: We found a prevalence of 33% for BMI obesity and a prevalence of 66% for metabolic syndrome. These are higher than those of the general Irish middle aged population and the accepted estimate of a general psychiatric population. It is also higher than that of a previous published study on an Irish long-stay psychiatric ward population.

Conclusion: There is high prevalence of BMI obesity and metabolic syndrome in long-stay psychiatric residents. This has the potential to impact significantly on physical morbidity and mortality. People with severe and enduring mental illness should have access to primary care and other health services on the same basis as any other citizen.

Objective: The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge.

Method: Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated.

Results: Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study.

Conclusion: Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.

Objective: This study was conducted to gauge the attitude of fifth year medical students to psychiatry as a potential career choice and to determine if an eight-week clinical attachment had any impact on this.

Methods: We surveyed a cohort of fifth year medical students from Trinity College Dublin. A purpose designed, self-completed questionnaire was used to establish a number of variables and was given to students on the first and last day of their attachment in psychiatry. Participation was optional and responses were confidential. Questionnaires were distributed following an explanation of the purpose of the study.

Results: The survey was applied to 118 fifth year medical students. The most significant finding of the study was the increase in number of students choosing psychiatry (17%) as a possible career upon completion of the attachment as compared to before (4%). The majority of the students considered psychiatry as a mainstream specialty with little change in this perception pre and post attachment. Almost all of the students believed that a psychiatry posting would improve their communication skills when dealing with patients.

Approximately half of students chose medical subspecialties as career choice prior to their psychiatry posting but this declined afterwards. There was a small increase in the number of students wanting to become GPs and those who were undecided about their potential career choice.

With regards to deterrents to doing psychiatry, the principal one was the belief that psychiatry was too depressing and stressful. Lack of interest, adverse career prospects and financial considerations featured in a minority of student answers.

Conclusions: The findings of this study suggest that psychiatry remains less attractive to students as a career compared to some other specialities but a clinical attachment may be an important means of raising interest in psychiatry as a career.

Priapism is a rare urological emergency, which can be associated with the use of psychotropic medication. The authors were able to find only one brief report of this condition in people with an intellectual disability. A case is reported in a man with moderate intellectual disability, who was receiving antipsychotic medication to manage extreme challenging behaviour. We discuss the condition and its implications for pharmacological treatments of behavioural disturbance in susceptible individuals.

The treatment of psychosis in patients with Parkinson's disease (PD) is one of the most difficult problems in clinical psychiatry. Clozapine's low propensity to induce extrapyramidal side effects makes it an attractive treatment for psychotic patients with PD. A number of published uncontrolled studies suggest that low-dose clozapine is effective in these patients. However, the dose range, side effect profiles and length of treatment have varied in these reports. In this article, the authors review the literature and report on the effects of clozapine in a patient with Parkinson's disease and psychosis. Clozapine (50mg per day) resulted in a complete resolution of psychosis, improvement of motor function, reduction of “off” time and a major improvement in levodopa-induced dystonic dyskinesias. The only adverse effect was mild sedation during the first two weeks of clozapine treatment. The lack of acute blockade of striatal D2 receptors by clozapine and the failure of chronic clozapine treatment to suppress striatal dopamine release may account for its beneficial effect in Parkinson's disease. Additionally, an ameliorating effect of clozapine on parkinsonism might be due to its action on serotonergic systems leading to release of striatal dopamine.

We present a descriptive study discussing the reasons why patients remained as in-patients within the psychiatric unit over the Christmas period. In over 50% of cases continuation of in-patient stay was necessitated by the severity of mental illness. However, a significant minority of patients were unable to leave because of either poor family support or reduced input from the community mental health services. There was some evidence of Christmas good will influencing admission policy with a significantly greater number of patients admitted with alcohol problems over the week before Christmas all of whom were lonely and expressed a preference to be in hospital.

A more long term problem was also evident as an important minority of patients' hospital stay was unnecessarily prolonged because of unavailability of suitable community placements.

Objective: Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women. Method: Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements. Results: Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted. Conclusions: Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.

A 31 year-old man with a history of a depressive episode presented with acute severe ‘thunderclap’ headache. Magnetic resonance imaging (MRI) revealed abnormalities typical of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), which was subsequently confirmed by genetic analysis. The psychiatric features of this genetic cause of depression and headache are discussed.

Following the withdrawal of methohexitone from the market place psychiatrists and anaesthetists have been forced to seek out alternative anaesthetic agents for ECT. We report a case of etomidate-induced seizure-like activity. We review the literature on ECT and anaesthetic agents and discuss the alternatives available in accordance with a statement by The Royal College of Psychiatrists.