Guidelines on advising patients on fitness to drive have been published recently by the Road Safety Authority in collaboration with the Royal College of Physicians of Ireland. The aim of this audit is to assess if the new guidelines are being adhered to.

Examination of the documentation and adherence to the guidelines in the inpatient psychiatric unit, Mayo General Hospital.

Of the 100 patients included in audit cycle one, none had any specific documentation about driving. One patient was admitted with alcohol misuse and was driving. On re-auditing, following presentation at academic meeting and education of team members on the guidelines, there was a minor improvement of 7%.

There was no significant difference in documentation on re-audit. However, an increase of 7% is nonetheless encouraging. Information concerning driving should be a standard part of advice given to all psychiatric patients.

The purpose of this paper has been to identify and describe the demographic, social and clinical characteristics of persons admitted to an Irish district lunatic asylum in the late 19th century as exemplified by the records of the Sligo District Lunatic Asylum. Some 21st century comparisons and epidemiological considerations from the same catchment area have been attempted.

The register entries and case books of a series of consecutive admissions to Sligo District Asylum during the decade 1892–1901 were surveyed in the Irish National Archive.

Most admitted patients were of lower socio-economic status, the majority male, poorly literate, unmarried and described as suffering from mania or melancholia. Most were first admissions. The predominant (62.5%) reason given for admission was for assault or threat of assault. These admissions were by order of the Lord Lieutenant as ‘dangerous lunatics’. Although it may be maintained that this admission process was a device of social convenience to maintain the peace and integrity of local communities and the convenience of families, clinical information indicates that the majority of admissions had symptoms of mental disorder recognisable in terms of 21st century psychiatric diagnostics.

Physical health and, in particular, frailty may be associated with psychological factors among older adults. We aimed to investigate the relationships between aspects of psychological distress and progression of frailty over time among older adults.

We used a longitudinal observational study design with 624 participants aged over 60 years (mean age=72.75, s.d.=7.21, 68% female) completing a baseline comprehensive biopsychosocial geriatric assessment, and 447 returning for a follow-up assessment 2 years later. Aspects of psychological distress, physical health, and frailty were analysed for the purposes of this study. We employed a series of logistic regression analyses to determine psychological predictors of changing states of aspects of frailty over time.

With individual components of frailty, neuroticism and age predicted negative transitions of exhaustion and grip strength, respectively, whereas age alone was a predictor of transitions in overall frailty scores based on four components.

We conclude that neuroticism and age may impact upon physical frailty and its progression over time in an ageing population. These findings may reflect the tendency for those with high levels of neuroticism to endorse negative symptoms, or alternatively, neuroticism may result in exhaustion via worry in an older population. Further research is required to further elucidate this relationship.

A variety of chronic painful conditions are present in the paediatric population. Patients with chronic pain often experience considerable scepticism and avoidance by health care providers. This meta-analytic review aimed to utilise well-designed studies, in examining the effectiveness of cognitive behavioural therapy (CBT) in the treatment of chronic pain in children and adolescents.

Nine randomized controlled trial studies examining CBT for chronic pain were reviewed. Outcome measures were child reported pain intensity, pain duration and functional disability.

CBT had a large effect on pain intensity for recurrent abdominal pain (RAP), a small effect on headaches, and a medium effect on fibromyalgia. CBT had a medium effect on pain duration across pain types. CBT had a large effect on functional disability for RAP, a small effect on fibromyalgia and a moderate effect on headaches. Findings are limited by the small number of studies and varied control conditions.

CBT may be effective in reducing child reported pain symptomology. Future studies using a larger sample and examining the differential impact of varied control conditions are needed.

Mirtazapine is indicated in the treatment of major depressive disorder particularly in selective serotonin re-uptake inhibitors resistance. Its effect on hair loss is rare with no previous documented effect on hair colour.

Review of relevant literature and description of a case report of a 54-year-old male patient who developed alopecia and hair discoloration after initiation of mirtazapine treatment.

Upon cessation of mirtazapine treatment full restoration of hair colour and regrowth of hair was attained within 10 weeks.

There was clear temporal relationship between experiencing hair loss and commencing mirtazapine treatment. No other more likely medical reason to explain such experience was established. A noticeable restoration of the hair colour occurred following mirtazapine cessation.

Mirtazapine is associated with hair discoloration and hair loss. The possibility of such distressing adverse effects needs to be conveyed to patients by clinicians and to be further explored by researchers.

The recovery approach provides a key organising principle underlying mental health policy throughout the English speaking world with endorsement by agencies such as the World Health Organisation. In Ireland, personal recovery is one of the quality markers identified by users of mental health services and has become central to national mental health policy.

The aim of this study was to explore the implications for mental health services and professional practice arising from a structured investigation of what personal recovery means for people using specialist mental health services and the extent to which services support their individual recovery.

Ten service user participants in a service initiative were assessed using a novel measure based on an empirically based conceptual framework of recovery. The INSPIRE determines the level of recovery promoting support received from mental health staff and the quality of the supportive relationship as perceived by individual service users.

A consistent pattern of beliefs about recovery in keeping with national guidelines and the international literature was apparent. All respondents indicated that support by other people was an important part of their recovery with high levels of support received from mental health professionals. There was less consistent endorsement of the quality of relationships with professionals and recovery-oriented practice as perceived by participants.

The findings are highly relevant to the development of recovery focused, clinically excellent services. Further work is needed to improve the process of translating recovery guidance into mental health practice.

To describe and discuss the portrayal of psychiatric illness in film and theatre.

A review of psychiatric literature on psychiatric illness and stigma was carried out. This was combined with a review of selected films and plays. The dramatic function of mental illness, and the manner of its portrayal, were considered in a discursive manner.

From Ancient Greek theatre to modern film, psychiatric illness has been used to exemplify “otherness”. This has frequently had connotations of danger and violence, either to others or to societal norms. Occasionally psychiatric illness is depicted as transformative, or an understandable reaction to an insane environment, and there is a trend towards more nuanced depictions of mental illness. However, the disproportionate association of mental illness with violence and danger is reflected in the public's perception of mental illness, and contributes to self-stigmatisation.

Ongoing communication between psychiatry, service users and the arts may help to challenge the stereotype of “mad, bad and dangerous to know”.

It is widely accepted that people with mental illness have increased risk of cardiometabolic complications such as obesity and type 2 diabetes mellitus. What is less well known is that individuals with diabetes have an increased risk of brain health complications including depression, cognitive impairment and dementia. These conditions can adversely influence disease self-management and further increase risk of other diabetes complications.

The aim of this paper is to highlight the increased risk of brain health complications in populations with diabetes in order to promote awareness of such complications among healthcare professionals and encourage timely intervention.

An overview of the prevalence and potential mechanisms linking depression and cognitive impairment with diabetes as well as implications for detection, management and brain health protection, based on a narrative review of the literature.

Early detection and effective management of depression and cognitive impairment among individuals with diabetes has the potential to minimise adverse health outcomes. In order to promote screening healthcare professionals caring for individuals with diabetes in all settings must be aware of the increased risk of brain health complications in this vulnerable population.

Facilitating mindfulness programmes within an inpatient mental health setting is discussed. The difficulty in effectively engaging patients at this acute stage in their illness is focussed upon. Other challenges discussed are identifying appropriate inclusion and exclusion criteria; identifying the optimal programme format for this setting; promoting mindfulness within the environment of the inpatient unit and the training requirements for programme facilitators. The article concludes that due attention should be given to these challenges in order to maintain the integrity of mindfulness as an effective intervention for mental health difficulties.

The purpose of this paper has been to investigate the vulnerability of staff in an Irish district lunatic asylum (1869–1950) to infection and injury as exemplified by the records of Monaghan District Asylum (renamed Monaghan Mental Hospital in 1924 and St Davnet’s Hospital in 1954). Some comparisons with other Irish district asylums are included.

The Minutebooks of Monaghan District Asylum, located in St Davnet’s Complex, Monaghan, were sampled in December of each year from 1869 to 1950 with the sampling extended outwards as required. In addition, the reports on the District, Criminal and Lunatic Asylums in Ireland (1869–1921) and the annual reports of the Inspector of Mental Hospitals (1923–2013) were surveyed for comparisons.

Staff in Monaghan District Asylum were vulnerable to infection from contagious diseases including typhoid, tuberculosis and Spanish influenza. As with other Irish district asylums, overcrowding was the norm and isolation facilities were either absent or inadequate. The close proximity of staff to patients in an overcrowded and frequently insanitary institution placed them at increased risk of contracting disease. Moreover, staff at all levels, from resident medical superintendent to attendant, were, on occasion, at risk of injury from patients. The Monaghan experience would seem to indicate that any consideration of staff patient relationships within asylums should be nuanced by a consideration of the risks posed to staff due to their occupation.