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.

Twenty-one drug free patients fulfilling the DSM-111-R criteria for major depressive disorder were administered an alpha2 adrenoceptor challenge test. They were then treated with an antidepressant or ECT. Six weeks later, alpha2 function was again tested and found to be universally downregulated in treatment responders. Those who failed to respond to treatment (33%) had evidence of continuing alpha2 adrenoceptor activity. These results suggest central noradrenergic overactivity as a possible mechanism for depression, which runs counter to the classic catecholamine hypothesis.

Two separate cases are reported in which a woman believed that her pet dog had been replaced by an identical double. The psychodynamic issues which these reports raise are discussed. In the Capgras delusion the double is usually a key figure in the life of the patient. These reports highlight the fact that this key figure may be a domestic animal.

Objectives: Initial examination of data held by the Mental Health Commission indicated a number of patients having repeated involuntary readmissions (defined as patients having three or more involuntary episodes in a calendar year). The Commission sought more empirical analysis of the data relating to these patients, to determine if there were any trends or commonality regarding their demographic characteristics, length of episode, and diagnoses.

Methods: From 1 November 2006 the Mental Health Commission has been notified of all involuntary admissions in Ireland under the Mental Health Act (2001). From this national database information on patients who have had three or more involuntary admissions per year was analysed.

Results: In the period studied there has been an overall reduction in the number of voluntary and involuntary admissions to Irish psychiatric hospitals and units. However, the use of involuntary admission remains constant at around 10% of all admissions. Seven percent (n=569) of involuntary admission orders in this four year period relate to two percent (n=121) of all involuntary patients. Patients who have experienced repeated involuntary admissions are predominantly male (59%), often have a diagnosis of schizophrenia, or schizotypal and delusional disorders (57%), or mania (20%), are in the age band 22-64 (80%) and more often live in rural counties.

Conclusions: Potential appears to exist to significantly reduce the number of involuntary admissions by focusing on the care given to patients who are repeatedly re-admitted. More analysis is needed of voluntary and involuntary re-admissions if inpatient facilities are to be effectively configured.

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.

Montelukast (a leukotriene receptor antagonist) is a commonly prescribed medication used in the management of asthma in both children and adults. It has been associated with a possible increased risk of various neuropsychiatric events in post-marketing analyses of clinical trial data and surveillance studies. When establishing a link between a medication and side effects, it is usual to establish and enquire whether there is a chronological relationship between the commencement of the medication and the onset of the symptoms.

We report a case where a number of unusual neuropsychiatric events were reported several years after commencement of montelukast in a young boy who may have a genetic predisposition and a likely psychological trigger. There was complete resolution of these symptoms upon the withdrawal of montelukast.

Suicide is recognised as the most devastating possible outcome of a schizophrenic illness. This study examined the characteristics of 15 schizophrenic patients who committed suicide. These patients were older and less socially isolated than noted in other research. Drowning was the commonest method of suicide and overall, the methods chosen were comparable to those reported among the general Irish population. A past history of deliberate self harm was common although no temporal relationship between such behaviour and suicide emerged. The findings are discussed in the light of the existing literature on this topic.

The history of psychiatry is the history of therapeutic enthusiasm with all of the triumph and tragedy, hubris and humility that this brings. As a result, the emergence of any new diagnosis, such as attention-deficit hyperactivity disorder (ADHD), needs to be greeted with caution, rigour and scientific objectivity, as well as compassion, therapeutic engagement and optimism. Although there is now little doubt that ADHD is a valid, useful diagnostic concept, and progress has been made, there is still considerable work to be done to establish its incidence, prevalence and biological underpinnings, as well as optimal therapeutic strategies. As with all mental illnesses, it is likely that knowledge will develop over many decades and diagnostic criteria will be refined in parallel. In the absence of definitive biological understanding, there should be particular caution about over-exuberant diagnostic expansionism unless it is accompanied by compelling evidence of therapeutic benefit for those diagnosed.

Individuals’ mental health and wellbeing are dependent on many social factors including housing, employment, education and adequate nutrition among others. These factors can influence at personal, family and community levels. The interlinked and cumulative impact of these social determinants needs to be ascertained to aid appropriate patient management, as well as to establish prevention and health education programmes. Some of these determinants also have to be recognised at policy level. It is crucial for clinicians to understand the role social determinants play in the genesis and perpetuation of mental and physical illnesses, so that appropriate social interventions can be set in place. Clinicians have a role to play in their clinical practice, as well as advocates for their patients and policy leaders. In order to ensure that health is joined up with other sectors, such as education, employment, judiciary and housing, policy-makers must avoid silos. Every policy must have an impact assessment on physical health and mental health. Policy-makers need to understand scientific evidence and must work with researchers, clinicians, communities and patients to help develop and implement rights-based policies.

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.

Background: Evidence from regions where there have been severe dietary restriction suggests that individuals in utero during periods of starvation may subsequently be at increased risk of schizophrenia. Because Ireland was the location of a major nineteenth century famine an attempt has been made to determine whether any such evidence for famine/schizophrenia association can be found.

Method: The data used derive mainly from the Annual Reports on the District, Criminal and Private Lunatic Asylums supplied by the Inspectors of Lunacy in Ireland for the relevant years. Nineteenth century diagnostic labels have been adjusted to conform to schizophrenia as currently understood. Evidence relating to a possible schizophrenia increase in famine-related emigrants is examined.

Results: There was an increase in first admission rates for schizophrenia of 85.7% from 1860 to 1875. Admissions for other disorders, chiefly melancholia, also increased. Similar admission increases were evident in other jurisdictions over the same period. Data relating to the mental health of famine – migrating Irish are sparse and of difficult interpretation.

Conclusion: The evidence from available data sources attempting to link the Irish famines of the 1840s with a subsequent increase in the incidence of schizophrenia is equivocal and inconclusive.

Objective: This study reviewed all inpatient admissions in a community oriented old age psychiatry service with the aim of assessing the appropriateness of admission criteria, obtaining a profile of those admitted, and providing information about service utilisation.

Method: A retrospective chart review of all first inpatient admissions from 1989-1993 was carried out. Information concerning sociodemographic and clinical variables, and outcome measures in terms of discharge destination, was obtained.

Results: There were 205 first admissions in the study period. There were 37 patients (18%) admitted on an involuntary basis. One per cent of admissions were not assessed at home prior to admission. Six patients had no formal psychiatric disorder, of the remainder 53% had an organic, and 47% a functional psychiatric disorder. Of those admitted 68% were discharged to their original destination. Patients with dementia were more likely to be discharged to nursing homes. Other discharge destinations were also used.

Conclusions: The policy of initial domiciliary assessment of all referrals prior to admission is feasible in the majority of cases. Defined admission criteria clarify reasons for admission, and ensures appropriate use of beds. The range of discharge destinations highlights the need for maintaining close ongoing links with other service providers.

Exposure to traumatic experiences in childhood is a risk (and potentially causal) factor for the development of a range of adverse physical and mental health conditions. In addition to the onset of clinical disorders, there is emerging evidence that childhood trauma may also be associated with other long-term outcomes, such as the persistence and severity of an individual’s symptoms, as well as their long-term social and occupational functioning. However, the reasons for this remain poorly understood. A greater understanding both of the mediators that drive these associations, and those variables that enhance resilience against such damaging experiences may help to inform effective therapeutic interventions. In addition to biological and cognitive measures, there is a need to consider social and environmental factors, such as parental bonding and attachment, when investigating these complex relationships.