Objectives: To determine the extent of mental health services provided in the community in one Irish health board area. To examine the influence of postgraduate mental health training of GPs on provision of mental health services.

Method: Questionnaire and focus group methods were employed to determine views on mental health service provision. Data analysis was with parametric and non-parametric tests of association including student's t and chi-squared tests. Thematic analysis of the focus groups was carried out.

Results: Twenty-five per cent of patients attending general practice have mental health problems and over 95% of these problems are dealt with in primary care. Only 32% of GPs had received postgraduate training in psychological therapies. GPs with postgraduate training in psychological therapies were more likely to estimate a higher proportion of their patient population with mental health problems and less likely to refer to psychiatric services. A need for support from other health care professionals in primary care was also identified.

Conclusion: The majority of patients with mental health problems are treated in primary care. Further training of GPs and increased resources would improve mental health care in primary care and lead to fewer referrals to psychiatric services.

Objectives: To ascertain the relationship between social network type and depression over time.

Method: A longitudinal outcome study of depressed elderly patients attending an old age psychiatric service was carried out. Subjects were seen at baseline and regular intervals over two years.

Results: Depression severity at baseline and at follow-up times differed according to subjects' social network. Those with more socially integrated networks had the best outcome and those who had more dependent networks had a poorer outcome. There was a lot of movement between networks over time for subjects, with many moving towards more dependent networks.

Conclusions: When treating depression in the elderly it is important to consider the social network and milieu in which the patient resides. Treatments should include strategies encouraging the maintenance and formation of social integration.

Objectives: As part of an outcome study of depression in older people, the relationship between physical disability and depression was explored at baseline and longitudinally. The aims were to identify whether illness in specific body systems or physical disability was associated with a poorer outcome of depression.

Method: Subjects over 65 with depression referred to an old age psychiatry service were recruited. Depression was diagnosed according to ICD-10 criteria. An in-depth initial assessment obtained data concerning depression severity and illness in specific body systems as well as disability levels. Objective and subjective ratings of health status were also made. Subjects were followed up at three, six, 12, 18, and 24 months. Ongoing assessments were made of depressive symptomatology and of physical status.

Results: Subjects with higher disability levels had more severe depression at baseline. There was no relationship between illness in specific body systems and depression severity. At follow up assessments, those with higher disability scores had poorer outcomes as recorded by depression rating scales and by reviewing the longitudinal course of depression in terms of proportions remaining well, suffering relapses or remaining depressed.

Conclusions: There is an ongoing relationship between depression and disability. Older people with greater physical disability have a poorer outcome of depression. Service providers should be aware of this relationship and respond rapidly and assertively to depression in older people with disability. There should be a lower threshold for initiating treatment in this population.

Objectives: To examine baseline testing and ongoing monitoring of cardiovascular and other risk factors in individuals prescribed atypical antipsychotic medications.

Methods: We derived a list of baseline and ongoing monitoring tests from the literature (Weight, BMI, blood pressure, U&E, LFTs, glucose, HbA1C, FBC, TFTs, prolactin, lipids & ECG) and then reviewed a random sample of 80 records of patients prescribed atypical antipsychotics and currently attending an Irish public catchment area service, for evidence of testing.

Results: Levels of testing for baseline tests ranged from 45% for blood pressure to 0% for BMI. Levels of ongoing monitoring tests ranged from 42.5% for U&E to 0% for BMI. Patients admitted to hospital were much more likely to have had testing.

Conclusions: The need for baseline and ongoing monitoring of certain tests in patients prescribed atypical antipsychotics is increasingly accepted. Levels of such testing are currently quite low and need to increase.

With advancements in medical science over past decades, our aging population has increased substantially. Census studies in 2001 showed that 429,100 of the population of the Republic of Ireland were aged 65yrs and older, making up 11.2% of the overall population. While the overall population of the Republic is expected to remain stable over the next ten years, the demographic projections for the elderly population is for significant growth: numbers of over 65yrs are expected to increase by nearly 108,000 people between 1996 - 2011, comprising over 14.1% of the overall population. In particular, our communities will contain a much higher proportion of octogenarians and nonagenarians: at present 21% of our over 65's are 80 yrs or older; by 2011, it is projected that this number will increase to 25%. In tandem, the prevalence of dementia will increase.

In 2000, it was estimated that 31,000 people suffered with dementia in the Republic of Ireland, and this figure is expected to increase by 5000 cases per year between 2001-2011. The ultimate outcome of this demographic shift, will be higher demands on medical services for older people, especially geriatric medicine and old age psychiatry. This paper will focus on two particular aspects of management which will increasingly impact on the work of old age psychiatrists – medicolegal issues and management issues in dementia.

The association between intellectual disability and offending is complex. Recent evidence would suggest that the received wisdom of intellectually disabled persons being more prone to offending is either incorrect or only tells part of the story. Those within the ‘borderline’ intellectual disability range may be more prone to committing sexual and criminal damage offences but those with an IQ less than 50 rarely offend.

The offender with intellectual disability shares characteristics with his counterpart from the general population. As with the general population as a whole, offending in this group is often unreported and its recognition is complicated by issues of competence. The lack of validated forensic assessment schedules for this population poses a further challenge. Some general approaches to assessment in this population are discussed. This case report illustrates the difficulties of assessing and managing offending behaviour in an individual with moderate intellectual disability. The challenge of treating offenders with an intellectual disability is immense and requires specialist expertise. Managing such cases in a generic setting is inappropriate and the need for a forensic learning disability service in Ireland is highlighted.

We report a case of erotomania with onset coinciding with a cerebrovascular accident in a 65-year-old woman. She believed Dick Haymes, a famous singer and actor who died in 1980 was in love with her, visited her and wanted to have sex with her. It is argued that the erotomania stemmed from an interaction between the frontotemporal impairment due to the cerebrovascular accident and personality factors.