This paper investigates the characteristics of those under inpatient psychiatric care in 1901 in the context of a policy formulated to provide institutional care and treatment for mentally ill persons. It presents data on admissions, discharges and deaths, their demographic and clinical characteristics and reported outcomes.

Young men are grossly over represented in Irish suicide statistics, yet this group is the least likely to use mental health services. This paper outlines why young men are reluctant to access mental health services, framing the problem in the context of risk factors for suicide such as binge drinking and social change. The paper argues that de-stigmatising mental illness and encouraging young men to seek help for emotional problems should be a priority for policymakers.

Objective: To assess the effectiveness of daily outpatient alcohol detoxification in an Irish public psychiatric hospital.

Method: The outpatient records of patients presenting to the Assessment Unit of St Brendan's Hospital in one year (August 2004-July 2005) with symptoms of Alcohol Dependence Syndrome (ADS) and commencing daily outpatient detoxification were examined retrospectively for parameters relevant to the objectives of the study. The results were compiled and analysed using descriptive statistics.

Results: Forty patients underwent outpatient alcohol detoxification in one year and complete records were available for 32 patients (80%). Twenty patients had fixed addresses in the hospital catchment areas, eight patients had no fixed addresses and the remaining four patients had addresses outside the catchment areas. Seven patients (22%) presented with a co-morbid psychiatric condition including depression (four patients), anxiety disorder (two patients) and personality disorder (one patient). All seven patients were known to psychiatric sector services. Of the 32 patients commencing detoxification, 28 patients (87.5%) attended on the second day whilst 22 patients (69%) attended their third day's appointment. Only 17 patients (53%) completed the outpatient detoxification. Thirteen patients (40.6%) received at least two outpatient detoxifications during the year; of whom seven patients (58%) received their second detoxification within two months of the first one. The record of 20 patients (62.5%) showed that they had received advice regarding selfreferral to counselling services.

Conclusion: A high proportion of patients (47%) presenting with symptoms of ADS did not complete daily outpatient detoxifications. A high proportion of all patients (40.6%) also underwent multiple outpatient detoxifications during the year. It is possible that the separation between alcohol detoxification and alcohol counselling services in Ireland contributed to these disappointing results.

Objective: The association between depression and cardiovascular disease has been well documented but the nature of this relationship continues to be defined. Given the accumulation of epidemiological evidence linking these diseases a number of interventional studies have been undertaken to assess the issue of whether antidepressant treatment in depressed patients with cardiovascular disease improves cardiac outcome. The objective of this paper is to review recent randomised controlled trials on this topic and to explore the implications that these may have for future research in this area.

Method: This review is derived from a MEDLINE search using the search terms ‘depressive disorder’ and ‘cardiovascular diseases’. Only randomised controlled trials published in English with clearly defined methods and interventions are included here. Reference sections from the articles were used to identify additional relevant studies.

Results: A small number of high quality trials were uncovered which indicated mixed results in terms of the treatment of depression in cardiovascular disease. None indicated a statistically significant difference in cardiac outcome.

Conclusions: It is not possible at this time to recommend treatment for depression to reduce cardiovascular risk. However depression remains prevalent in patients with cardiovascular disease and is a treatable cause of morbidity in its own right.

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.

A Vision for Change, the report of the Expert Group on Mental Health Policy asserts as one of its key recommendations the enhancement and formalisation of links between specialist mental health services and primary care. As part of a higher training post in psychiatry a consultation-liaison service was provided by a senior registrar in three rural general practices. This paper describes the experience of this initiative from an educational perspective and discusses the broader implications for Irish psychiatric training. With an emerging emphasis on collaborative mental health care there needs to be an appreciation of the specific set of skills that psychiatry trainees must learn in order to be effective in primary care settings. The tandem development of the appropriate services and training in an Irish context will require dedicated funding and resources.

We report a 45 year old man with neuroleptic-induced dyskinesia for whom deep brain stimulators (DBS) were implanted in the globus pallidus internus (GPi). We describe a significant improvement in his symptoms. Lastly, we review briefly the success of deep brain stimulation to date, and discuss the clinical implications for individuals who develop movement disorders during neuroleptic use.

Objective: To measure the impact of a six-week Carer Psychoeducation Program (CPP) on factors that influence attitudes towards treatment among carers and relatives of people suffering from schizophrenia. We also examined which specific attitudes to treatment the CPP had the most effect on.

Method: Between 2002 and 2004, all patients and their relatives continued standard care. During this period, we conducted a historically-controlled open trial, in which 64 relatives completed a 17-item adapted version of the Drug Attitudes Inventory (DAI) before and after the CPP.

Results: Attitudes to treatment improved significantly overall (p < 0.001), an improvement most marked in terms of attitudes to health and illness, attitudes towards the physician and attitudes towards the potentially harmful effects of treatment. No statistically significant improvement was found, however, in attitudes to locus of control or the preventative role of treatment.

Conclusion: A CPP specifically improves family attitudes towards treatment. This finding is clinically important because such attitudes influence adherence which, in turn, influences outcome. The fact that certain attitudes are influenced by the CPP, while others are not, may help to explain the mechanism through which patient outcomes improve.

Objective: A paucity of research exists on the types of patients admitted to psychiatric intensive care units (PICUs), which is important in terms of identifying patient needs, training and service provision. Questions have also been raised as to whether or not ethnic minorities are overrepresented in these units.

Method: A literature review using MeSH headings from a wealth of databases was performed to identify such studies. In addition studies on ethnic minority overrepresentation in psychiatric care were also identified.

Results: Under a dozen studies were identified, mainly from the UK and Australia. Study designs tended to be basic and heterogeneous, but this was reflected in the nature of the study and the data gained. A typical PICU patient emerged, namely a young schizophrenic detained male, belonging to an ethnic minority (if in an inner city), known to mental health services with previous informal, detained and PICU admissions, admitted due to violence and often possessing a forensic history. If a complex need existed, it was usually substance misuse. The inpatient stay tended to be for less than two months and discharge was usually to an acute ward. Ethnic minorities were overrepresented in PICU care.

Conclusions: The literature review highlighted a paucity of good-quality studies in this field. The establishment of a national association of intensive care units as well as national guidelines can only improve services. The reason for ethnic minority over-representation on these units is still far from clear.

The Irish State has been party to a collection of international treaties and declarations that directly affect the care of those who suffer from mental disorders. These documents set up what are considered as minimum core standards that outline the standard of care that should be provided as a basic human right. This article reviews the relevant sections of these documents and reflects as to how they have been applied in Ireland. International conventions, which have the status of a treaty, are monitored and interpreted by various commissions and committees. This article draws on the comments of these bodies as to how a state should provide for those with mental illness. Areas such as the rights of children who are mentally ill and those who are detained by the state are examined in detail. Other areas covered are the right to the highest attainable level of mental health care, the right not to be subjected to a clinical trial, equal access to mental health care, and the right to be safeguarded against unjust involuntary detention.

Disulfiram is widely used for the aversive treatment of alcoholism. It is well tolerated in most patients; however 1:15,000 will develop peripheral neuropathy, which is frequently misdiagnosed as alcoholic neuropathy. Most cases present with a motor-sensory neuropathy of the lower limbs, which tends to improve when administration ceases, though some cases may be left with permanent sequelae. This adverse reaction can be avoided by using the lowest effective dose. A literature review using the Medline revealed 66 citations relating disulfiram to peripheral neuropathy, and the number of cases reported is small.

We describe two case reports presenting approximately one year apart These indicate a possible association between clarithromycin and psychosis. Such an association presents new challenges for clinicians based in non-psychiatric hospital settings and primary care physicians.

We describe a young African male presenting to an Irish psychiatric service with first episode psychosis with an acute onset, no prodromal features and early and complete remission. Migrant and ethnic minority groups may differ in their clinical presentation, course and outcome of psychosis compared with the Caucasian population. This has implications for assessment and treatment of ethnic minority patients in an Irish context given the recent migration into a previously homogeneous population.

Clozapine is an atypical anti-psychotic medication that has proved useful in the management of both psychotic and mood disorders and that has been shown to decrease aggression and the risk of suicide, which suggests that clozapine may be useful in the management of severe borderline personality disorder. Here we present the case of a 36 year old female with severe borderline personality disorder with symptoms of psychosis, aggression and violence. We discuss how treatment with clozapine resulted in a marked clinical improvement in this patient.