The full implementation of the Irish Mental Health Act 2001 brings about the introduction of an altered legal definition of mental disorder, mandatory review of involuntary detention within a 21-day period and new statutory rules regarding the use of seclusion and mechanical means of bodily restraint. This legislation came into full effect on November 1, 2006. The implications of this for the intellectual disability psychiatry sector are profound and the full ramifications of these changes will only become fully apparent over time.

This also occurs at a time when we are facing unprecedented developments in government mental health policy, major changes to postgraduate training in psychiatry, difficulty recruiting appropriately skilled staff and increasing legal requirements on employers to ensure staff safety. Several of these drivers for change may appear at face value to be in conflict and a complex balance will be required if these changes are to be blended to ultimately improve the care provided to clients of our services.

Objectives: To examine a sample of adults with mental health disorders attending at an area psychiatric service, for the presence of impairments in language, communication and swallowing, using a test battery administered by speech and language therapists.

Method: The study surveyed a randomly selected sample (n = 60) of patients from an acute psychiatric inpatient unit and associated community services, using several standardised measures of language, communication and swallowing.

Results: On this test battery, over 80% (50/60) of subjects studied demonstrated impairment in language; while over 60% (37/60) presented with impairment in communication and discourse. Over 30% (18/58) of subjects assessed showed some impairment in swallowing.

Conclusion: Use of this test battery confirmed the presence of language, communication and swallowing impairments in many patients in this sample of attenders at a general psychiatry service. We suggest that this study provides evidence for a (currently unmet) need for specialist speech and language therapy assessment and support among this patient population.

Objectives: This study evaluated the effectiveness of group cognitive behavioural therapy (GCBT) for the treatment of anxiety disorders in children over an initial period of 12 weeks and to one-month follow-up. Parents of the children receiving GCBT participated in adjunctive psycho-education sessions and the effect of these sessions on parental anxiety was also evaluated.

Methods: Participants were 12 children, six male and six female, aged between 11 and 15 years who were attending a child mental health service. Participants were interviewed with their parents and anxiety symptoms assessed, using the following measures: Anxiety Disorder Interview Schedule – revised, the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Coopersmith Self-Esteem Inventory and the Child Behaviour Checklist. Parental anxiety levels were assessed using the Depression, Anxiety and Stress Scale. The 12 children were randomly assigned into two age- and sex-matched groups. While the first group received therapy, the second group acted as a treatment-as-usual control (TAU) group. The second group began group cognitive behavioural therapy after the 10-week waiting period. All participants and their parents provided structured feedback on the intervention.

Results: Group cognitive behavioural therapy was significantly effective in reducing both child-reported depressive symptoms, and anxiety on the physiological, worry and total anxiety subscales of the Revised Children's Manifest Anxiety Scale. There were associated significant increases in the childrens' subjective levels of general and total self-esteem, that relating to their self-confidence with peers and when engaging in social and academic pursuits. Diagnosis of anxiety disorder reduced by an average of 67% immediately post-treatment, and by 72% by the onemonth follow-up period. Parents reported significant reductions in their children's levels of internalising symptoms, thought and attention problems. However, parents reported no significantly positive changes in their own levels of depression, anxiety and stress symptoms.

Conclusions: Group cognitive-behavioural therapy is a useful and clinically effective intervention for the treatment of anxiety disorder in children.

Objective: To examine the variables that influence of duration of untreated psychosis (DUP) prior to presentation in persons with a first episode of psychosis.

Method: Prospective examination of consecutive first presentations with DSM-IV psychosis attending a community based psychiatric service.

Results: One hundred and seventy-one patients had an average duration of untreated psychosis of 18 months and a median of five months. The mean duration of untreated mania was 1.5 months, median 0.75 months. DUP was predicted by social withdrawal and diagnosis in the total group and by prodrome in the schizophrenia/schizophreniform group. DUP was not associated with age at onset of psychosis, educational years or living status.

Conclusions: There are significant differences in DUP between diagnostic groups. Increased social withdrawal is associated with a longer DUP.

Objectives: Historical information is central to decision making in mental health care. Clinical information in the Irish mental health services is currently mostly paper based. Mental health care in Ireland has moved from an institutional medical model towards a community based multidisciplinary model in recent years. This change has resulted in a dispersal of information between multiple sites and professionals, rendering it less accessible, particularly in emergency settings.

This study sought to find out if psychiatrists working in Ireland were experiencing information problems, their ideas about and attitudes towards electronic solutions to these problems, and their views as to what particular pieces of information are indispensable in emergency mental health assessments.

Method: A questionnaire was designed to answer these questions and sent to a representative sample of 150 psychiatrists working in Ireland.

Results: One hundred and nineteen questionnaires (79.3%) were returned complete. Of the 119 respondents 98(82.4%) stated that they had performed emergency mental health assessments within the past year without access to key information and 79(66.4%) said they would have made different decisions in some cases had they had all the available information. Information deficits were particularly apparent in liaison and forensic psychiatry.

Of the respondents 110(92.4%) stated that they would welcome an electronic database designed to support emergency mental health assessments. Misgivings were expressed regarding forms of consent, data quality, breach of confidentiality, resources and much more. Risk factors (ie. self-harm potential), a high alert message and medication details were the data items thought to be most critical.

Conclusions: A shareable set of essential pieces of information (a minimum data set) would offer a balance between patient safety, confidentiality and shareability. A wider debate about solutions to the information deficits in mental health care in Ireland needs to take place among all stakeholders so that this idea can be moved forward.

First admissions for schizophrenia to inpatient psychiatric services in Ireland are declining. The reason for this decline has been debated and it has been proposed that it could be attributable to either a decline in incidence or to policy changes or to both.

Objectives: This study examines the trends in first admission numbers for schizophrenia in Ireland and the influence of gender and marital status on age at first admission over the time period 1971-2004.

Method: Data were derived from the National Psychiatric Inpatient Recording System (NPIRS) for the years 1971-2004 inclusive. All first admissions with a diagnosis of schizophrenia during these years were included in the analysis.

Results: The results showed a significant decline in the number of first admissions with the number of first admissions for males exceeding those for females. The average age of first admission was higher for females than males (p < 0.001). The average age of first admission showed a decline for males (p < 0.001), but not for females. Marital status was a stronger predictor of age of admission than gender (p < 0.001). Never married persons had a lower age of first admission than those married and the delaying effect of marriage on age at first admission was evident in males and females (p < 0.001).

Conclusions: An examination of first admission hospital data confirm male disadvantage in schizophrenia. The study highlighted a number of areas for future research which include examining gender differences in more refined diagnostic sub groups of schizophrenia and the monitoring of first contacts with community-based mental health services.

Objective: The aim of this study was to determine the prevalence of risk factors for physical illness in a long stay psychiatric unit, where all care (both psychiatric and physical) is provided by the psychiatric team.

Method: All patients in the long-stay ward had a full physical examination including calculation of BMI. All patients had blood sampling including FBC, U&E, LFTs, TFTs, lipid profile (total cholesterol, triglycerides, HDL and LDL), glucose, HbA1c, and prolactin. ATP111 criteria were used to determine the presence of the metabolic syndrome.

Results: We found the mean number of comorbid medical diagnosis was 2.7. The prevalence of metabolic syndrome was 40.7% (44.4% of females and 24.1% of males). The prevalence of obesity was 51%, and 51% also had a total cholesterols in excess of 5.0mmol/l. Prolactin was elevated in two-thirds of female patients.

Conclusion: We conclude that the annual physical examination is of limited value in long-stay psychiatric unit. The high prevalence of physical illness and physical risk factors warrants primary care involvement in screening and treatment of long-stay psychiatric patients.

Objectives: This study examined the validity of a latent class typology of adolescent drinking based on four alcohol dimensions; frequency of drinking, quantity consumed, frequency of binge drinking and the number of alcohol related problems encountered.

Method: Data used were from the 1970 British Cohort Study 16-year-old follow-up. Partial or complete responses to the selected alcohol measures were provided by 6,516 cohort members. The data were collected via a series of postal questionnaires.

Results: A five class LCA typology was constructed. Around 12% of the sample were classified as ‘hazardous drinkers’ reporting frequent drinking, high levels of alcohol consumed, frequent binge drinking and multiple alcohol related problems. Multinomial logistic regression, with multiple imputation for missing data, was used to assess the covariates of adolescent drinking patterns. Hazardous drinking was associated with being white, being male, having heavy drinking parents (in particular fathers), smoking, illicit drug use, and minor and violent offending behaviour. Non-significant associations were found between drinking patterns and general mental health and attention deficient disorder.

Conclusion: The latent class typology exhibited concurrent validity in terms of its ability to distinguish respondents across a number of alcohol and non-alcohol indicators. Notwithstanding a number of limitations, latent class analysis offers an alternative data reduction method for the construction of drinking typologies that addresses known weaknesses inherent in more tradition classification methods.

Objectives: Patients with schizophrenia are known to be at higher risk than the general population of cardiovascular disease. Clozapine has been associated in the literature with high levels of cardiovascular risk factors such as weight gain, diabetes, hyperlipidaemia and hypertension. We set out to determine the prevalence of these risk factors in a population of Irish psychiatric patients.

Method: In February 2006 we measured body mass index, fasting blood glucose, haemoglobin A1c (HbA1c), lipid levels, mean blood pressure and smoking rates among all outpatients prescribed clozapine attending an urban, community based mental health service.

Results: There were 50 outpatients (33 male; 17 female) on clozapine and they had been taking it for a mean of 5.4 years (mean daily dose 428.8mg). The mean body mass index was 28.3. Patients had gained a mean of 8kg since commencing clozapine. One patient had been diagnosed with diabetes. Of the other 49 none met diagnostic criteria for diabetes. The mean fasting blood glucose was 5.5mmol/l and the mean HbA1c was 5.7%. One patient was on treatment for hyperlipidaemia. The mean fasting cholesterol among the other 49 patients was 5.4mmol/l, while the mean fasting triglycerides was 2.1 mmol/l. Thirty (61.2%) had a fasting cholesterol greater than 5.0mmol/l, while 18 (36.7%) had triglycerides of greater than 2.0mmol/l. Three patients were on treatment for hypertension. Thirty-six of the 50 (72%) smoked (mean 13 cigarettes per day).

Conclusions: The prevalence of obesity, diabetes, hyperlipidaemia and hypertension in this population was high but lower than might have been expected from US studies. It is important that cardiovascular risk factors are closely monitored and actively addressed in this at risk population.

Objectives: National Institute of Clinical Excellence guidelines indicate that pre-surgical assessment of patients wishing to undergo bariatric surgery should include consideration of psychological factors. This paper describes the psychological characteristics of a cohort of 59 patients.

Method: Patients were interviewed and completed the following psychometric assessments: the Hospital Anxiety and Depression Scale, the Dieting Belief Scale, the Binge Eating Scale, the Emotional Eating Scale, the Generalised Self Efficacy Scale, and the Social Support Questionnaire.

Results: High levels of psychological distress and binge eating were reported. Men more commonly reported a history of alcohol misuse. There was evidence to suggest that psychological distress predated obesity in the majority of cases.

Conclusion: Compulsive eating leading to obesity appears to be both a consequence and a cause of psychological distress. Replacing compulsive eating represents a major post-surgical challenge in the majority of cases. Psychological assessment and follow-up should be offered to each patient.

Objectives: The aim of this study was to examine and describe levels of psychological health and well-being in a group of young people living in Dublin.

Method: A sample of 97 young people (50 males, 47 females) were assessed for psychological status, suicidal ideation, substance misuse, contact with the law, self-esteem and locus of control as well as various social indicators such as educational attainment and social connectedness. A screening version of the Structured Clinical Interview for DSM-IV Axis Diagnosis (SCID) was used to assess psychological functioning and the Beck Scale for Suicide Ideation was employed to ascertain suicidal ideation. Self-esteem was measured using the Rosenberg Self-Esteem Scale and locus of control was measured using a scale devised by Pearlin, Menaghan, Lieberman and Mullan (1981).

Results: Symptom levels were high and approximately one fifth of respondents had a probable psychiatric condition (most commonly depression or anxiety). Yet, only a small percentage was receiving treatment for psychiatric difficulties. Over half of the participants had used nonprescription drugs at some time. Alcohol consumption was high, especially amongst male respondents. Over half of those interviewed were categorised as misusing alcohol and/or drugs and participants greatly underestimated their level of alcohol use. Approximately one-quarter had had some contact with the law which was related to deficits in educational attainment and the latter variable was associated with childhood economic disadvantage.

Conclusions: These findings suggest that among a sample of 97 young Irish people, a high level of psychiatric symptomatology and excessive use of alcohol is evident. This remains largely untreated as only a small percentage of the group had sought help for psychological difficulties which suggests a need to address the issues of mental health awareness, alcohol use and the accessibility of services. The paper also underlines the association between economic disadvantage and lack of educational attainment with associated linkages to offending.

Recent reports from the Inspector of Mental Health Services have highlighted marked variations in electroconvulsive therapy (ECT) prescriptions nationally. This article reviews six international guidelines in order to assess the question of which patients should be referred for ECT treatment and at what stage in their illness. The guidelines display a general consensus in terms of the acutely and severely ill, but differ dramatically in terms of access to ECT outside this category, such as the moderately depressed patient who is treatment resistant but non-psychotic and non-suicidal and who requests ECT due to a previous good response.

The American Psychiatric Association guidelines strongly support the early consideration and use of ECT, highlighting the dangers associated with increased length of illness for individual prognosis. The National Institute of Clinical Excellence (UK) guidelines are the strictest, reserving ECT for the severely ill exclusively and only in cases with a demonstrable failure of alternative treatments. This confusion may ultimately need to be addressed by the Mental Health Commission as data relating to variations in practice may result in inappropriate reductions in access to an established treatment.

Objectives: The aim of this study was to assess the prevalence of alcohol dependence and anxiety and depressive disorder symptomatology among heroin users in drug treatment.

Method: Fifty-five clients on methadone maintenance treatment programmes in Dublin were interviewed.

Results: Prevalence rates were found to be 56% [n = 31] for alcohol dependence, 56% [n = 31] for anxiety disorder symptomatology, and 42% [n = 23] for depressive disorder symptomatology. This finding of comorbid alcohol dependence and psychopathology among methadone maintenance treatment clients suggests that both clients' health and methadone maintenance treatment participation and completion rates may be compromised.

Conclusions: Alcohol dependence and psychopathology among methadone maintenance treatment clients should be considered when providing effectively targeted services to the drug using population.

Objectives: To examine the relationship between cognitive deficits, the duration of untreated psychosis (DUP) and positive and negative symptoms in a first episode psychosis sample.

Method: We assessed a consecutive sample of first episode psychosis participants from a catchment area service with a comprehensive neuropsychology battery, a family and service-user based measure of DUP and measures of symptomatology.

Results: Using correlations and stepwise linear regressions, we found strong relationships between measures of DUP and positive symptomatology. We found that positive and negative symptoms were associated with different time periods within DUP. However, we did not find evidence of a relationship between DUP and cognitive factors.

Conclusions: There was no evidence of a relationship between DUP and cognitive deterioration. However, there does appear to be evidence of a relationship between positive symptoms and aspects of DUP. These results highlight the importance of the heterogeneity of DUP and the potential to reduce positive symptoms through early intervention.

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.