Objectives: In an earlier qualitative study we explored the attitudes of young men aged 15-19 (Group A) to mental health and, in particular, to engaging with the various mental health services available. We found that the participants perceived stigma in connection with mental ill health and they displayed particularly strong negative attitudes in relation to both doctors and medication. The investigation was then repeated with students who had been given a short (less than two-hour) programme called ‘Beat the Blues’ (BTB) about mental health (Group B) in order to assess the effect of that exposure by comparing the attitudes of the two groups of students. This present phase of the analysis is a quantitative examination of the written responses by both Groups A and B to an administered questionnaire.

Methods: A total of 42 young men took part in eight focus groups held in boys-only Dublin secondary schools, described in Burke et al. A questionnaire, administered to each participant, examined the students' attitudes to depression and mental illness. The results were analysed by computer using SPSS to search for any trends and any contrasts between groups A and B and among the different socio-economic groups (SEGs) within the sample.

Results: Almost no statistically significant differences were found between groups A and B. However, some differences were found among the SEGs. In particular, very significant differences (p < 0.01 in each case), were found in attitudes towards depression, with increasing support for statements such as “People with depression just need to snap out of it”, “Drinking alcohol can help cure depression” and “Depression is only an excuse for laziness” found among the lower SEGs. A very high percentage of students indicated their desire to talk to someone in times of personal stress; this was almost always their best friend or their mother. However, most students said they would be uncomfortable if a friend raised such a topic.

Conclusion: The main conclusion – that a single exposure to a positive programme about depression produces little or no effect – is hardly unexpected. Nonetheless, there are indications of a great willingness among older secondary students to learn about and discuss mental health issues. Furthermore, the highly negative attitudes among students from the lowest socio-economic group in this study would seem to indicate that the greatest need for education about mental health lies with working-class adolescents. Hence, it is recommended that a programme of multiple interventions be introduced into the senior cycle of secondary education.

Objectives: The Irish national mental health policy document, A Vision for Change, included recommendations to develop specialist rehabilitation mental health services. This survey was conducted as part of a multicentre study to investigate current provision of mental health rehabilitation services in Ireland and factors associated with better clinical outcomes for users of these services. The aim was to carry out a detailed national survey of specialist rehabilitation services in order to describe current service provision.

Method: A structured questionnaire was sent to consultant rehabilitation psychiatrists in all mental health catchment areas of Ireland that had any rehabilitation services to gather data on various aspects of service provision.

Results: Twenty-six of the 31 mental health areas of Ireland had some form of rehabilitation service. Sixteen teams working in 15 of these areas fulfilled A Vision for Change criteria to be defined as specialist rehabilitation services and all 16 responded to the survey. The overall response rate was 73% (19/26). Most services lacked a full multidisciplinary team. Only one service had an assertive outreach team with acceptable fidelity to the assertive outreach model. Urban services were less well resourced than rural services.

Conclusion: This is the first national survey to describe the provision of mental health rehabilitation services in Ireland. Although there has been an increase in the provision of consultant-led specialist rehabilitation services nationally, these services lack multidisciplinary input. There also appears to be a lack of planned provision of the facilities required to provide comprehensive rehabilitation services with unequal distribution of resources between urban and rural areas. This has potential cost implications for local mental health services in relation to ‘out of area treatment’ placements and perhaps more importantly to the overall quality of patient care.

Objectives: To investigate schema modes currently activated in individuals with psychiatric disorders and to attain a greater understanding of healthy and dysfunctional schema modes in this population. Furthermore, we wish to ascertain if individuals who fulfil criteria for clinical (psychiatric) disorders with the Minnesota Multiphasic Personality Inventory (MMPI), also manifest dysfunctional modes and weaker healthy modes on the Schema Mode Inventory (SMI).

Method: Fifty individuals were administered the MMPI and SMI during routine psychological assessments between September 2008 and June 2010.

Results: Both healthy schema modes (Happy Child (HC) and dysfunctional schema modes (Compliant Surrender (CS), Detached Self-soother (DSS) and Demanding Parent (DP)) were evident in this population. Positive correlations were noted between several dysfunctional schema modes from the Child, Maladaptive Coping and Maladaptive Parent domains of the SMI and several scales of the MMPI including: Depression (D), Psychopathic deviate (Pd), Masculine feminine (Mf), Paranoia (Pa), Psychasthenia (Ps), Mania (Ma), Schizophrenia (Sc), and Social introversion (Si) (p < 0.001). A negative correlation (p < 0.001) was found between the Healthy Adult (HA) and Happy Child (HC) schema modes of the SMI and the Hypochondriasis (Hs), Depression (D), Psychopathic deviate (Pd), Psychasthenia (Pt), and Social introversion (Si) scales of MMPI.

Conclusion: This study demonstrates the presence of several dysfunctional schema modes in individuals with a wide range of clinical (psychiatric) disorders and a strong correlation between dysfunctional schema modes and clinical disorders of the MMPI. The SMI can aid in the assessment and understanding of individuals with a wide range of psychiatric disorders and can also form the basis for Schema Focused Therapy (SFT), a therapy showing promise for a number of clinical conditions, particularly borderline personality disorder.

Objectives: The survey was designed to evaluate the current prescribing practice of the doctors in our local psychiatric unit against the standards outlined by the National Health Office in the Code of Practice for Healthcare Records Management, and to assess the changes in practice by completing an audit cycle.

Method: The survey was carried out in a 27 bed acute psychiatric unit. A single assessor reviewed 51 inpatient drug prescription charts using a standardised data collection form derived from the Code of Practice document. Results were presented to the relevant clinical staff and a repeat survey was conducted a few months afterwards. All data were categorical and the frequencies were computed using SPSS 13.0.

Results: A total of 51 medication prescription charts were analysed on each occasion during the period of the study. The information contained on the drug charts were assessed against explicit predefined criteria as per the approved standard. At the initial survey, allergy documentation was absent in 59% of charts, only 18% of charts had generic only prescriptions, 90% of ‘as required’ medication lacked review dates, and only 33% of charts were considered to be reasonably neat. The repeat survey showed improvements in these practices, generic only prescribing increased to 39%, and 55% of charts were considered to be reasonably neat by the assessor.

Conclusion: Our study has identified deficiencies in prescribing practices and we have shown improvement in some of these practices at the repeat survey, however, further improvement is required. Given that the non-consultant hospital doctors are mostly involved in prescribing on drug charts, approved standards should be incorporated into the induction programme at the commencement of training in this unit. This standard should be monitored and maintained through the means of regular audits.

Objectives: The objective of this study was to ascertain the topics patients and mental health professionals thought should be covered in a psychoeducation programme at a day hospital.

Methods: Patients at the psychiatric day hospital and mental health professionals were invited to complete the study questionnaire. Replies from 101 participants were analysed.

Results: The patients and mental health professionals generally agreed regarding the topics to be covered in the eight-week psychoeducation programme. Patients tended to score ‘suicide’ as more important than did the mental health professionals.

Conclusions: Patients in a day hospital setting and mental health professionals share similar concerns about what information needs to be imparted about the patients' illnesses. However, suicide is seen by patients as a more important topic in such a setting.

There is an established ethical and legal duty upon psychiatrists to obtain informed consent before treating a patient, although some exceptions do apply under Mental Health Legislation. The required standard for informed consent has been the subject of important case law in Ireland and other common law jurisdictions and this has caused some uncertainty for clinicians. The standard of informed consent can be viewed from the point of view of what the medical profession thinks is appropriate, or alternatively from the position of what a patient would reasonably expect to be told. These contrasting approaches are discussed in detail. A recent decision of the Irish Supreme Court establishes the ‘patient-centred’ standard for informed consent as the relevant standard in Irish law. The current legal position on informed consent is discussed in relation to common clinical scenarios in psychiatric practice.

Dr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.

We describe an unusual cause of autobiographical memory loss in a 55 year old man who presented with prominent memory loss for significant events in his life over a period of five years with evidence of patchy memory loss for events prior to this. It was associated with emotional lability and was complicated by a number of tragic events in his life in the previous four years. In addition there were a number of brief episodes (< 30 mins) where he would transiently lose his memory for events including for hours, days or months prior to the event. Neuropsychological assessment confirmed prominent autobiographical memory loss with minimal deficits in other domains. An electroencephalogram (EEG) revealed a simple partial seizure arising from the right temporal lobe, pointing to a diagnosis of Transient Epileptic Amnesia. He was commenced on anti-epileptic medication and responded both subjectively and objectively. There are approximately 94 cases of TEA described in the literature and the diagnostic criteria and postulated aetiology of this illness is discussed here. Clinicians need to have high index of suspicion of epilepsy when assessing a patient with prominent autobiographical memory impairments.

Although hyperprolactinaemia is associated with galactorrhoea, galactorrhoea often occurs without any hyperprolactinaemia. This has been well established, and it has been documented in women prescribed/using methadone and other opiates. One case series described amenorrhoea and galactorrhoea in ‘female heroin addicts’, but it has not before been described in a patient with hypoprolactinaemia.

We report a case of a 30 year old non-pregnant, non-puerperal, opioid-dependent, HIV positive woman on long-term methadone maintenance programme, who presented with bilateral, milky nipple discharge, associated with painful breast lumps, but with serum prolactin levels below the normal range. She was not prescribed any other medications likely to have effect on the endocrine system. This case highlights the need for prescribers to be alert to the implications of long-term use of opioids.

Serotonin toxicity is a potentially life-threatening condition associated with a range of psychotropic medications, co-administration of specific combinations of agents and overdose of certain drugs. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious complications, including possible death. Diagnosis is often challenging and requires a high index of suspicion. Differential diagnosis includes syndromes such as neuroleptic malignant syndrome. Management depends on the causal agent and urgency of clinical presentation. Treatment may involve discontinuing the causal agent and providing supportive measures, or emergency intervention to preserve vital functions (airway, breathing, circulation), amongst other measures. Further research is needed to clarify the incidence of serotonin toxicity, issues related to differential diagnosis, optimal management of the condition, and treatment of mood problems following serotonin toxicity.