Historically Western medicine has been divided into two main schools that were based on the ancient Greek tradition. These are the Hygeian school, based on the views of Hippocrates (born 460 BC), and the Asclepian school which is named after the Greek god of medicine but probably based on the physician Asclepius who was said to have performed miracles!

In brief, the Hygeian school of medicine views health as a natural state of the body. The body is believed to be endowed with inherent healing powers which, if one lives in harmony with these powers, maintains health and helps to restore it should it become impaired. Disease is seen as a manifestation of a weakness of the inherent healing powers of the body and the function of the physician is to help the patients to live within the natural law (vis medicatrix naturae) and to remove impediments to those mechanisms that maintain and restore health.

The second school that has profoundly influenced the development of modern medicine is the Asclepian school which arose in about 1200 BC around the teaching of Asclepius. This school focuses on diseases, their causes and cures. Each disease is considered to be the effect of, or response to, a specific cause that primarily affects a specific organ system. For every disease it is postulated that there is a specific drug or procedure which can alleviate the symptoms or cure the disease. Thus, the successful physician is the one who can make the correct diagnosis and prescribe the correct therapy.

Objectives: To investigate effects on one psychiatric inpatient service of a 40% reduction in the number of acute beds and the establishment of an acute day hospital.

Method: A retrospective review of all public admissions to the acute inpatient unit during two three-month study periods; before and almost three years after the changes. Review of attendance at the acute day hospital during the second study period.

Results: The number of admissions actually increased by 3% from 169-174; the mean duration of stay fell from 27-17 days; and the number of brief admissions of three days duration or less almost tripled from 15-43. Although fewer patients suffering from schizophrenia were admitted in the second study period than in the first, their mean duration of stay and the frequency of re-admission within 28 days of discharge changed little, while patients with diagnoses of mild/moderate depression and substance misuse experienced significantly shorter admissions and higher readmission rates. The use of temporary orders under the Mental Treatment Act (1945) doubled, and the readmission rates within 28 days increased by over 60%.

The acute day hospital treated 98 patients who had a diagnostic profile similar to that of the inpatients; 53% of them required admission before and/or after attendance at the day hospital.

Conclusions: The major reduction in the number of acute inpatient beds and the opening of an acute day hospital resulted in greater concentration of inpatient resources on the more severely ill patients. The increase in re-admissions and the failure to effect a reduction in admissions and may have a complex aetiology and merits further investigation.

Aim: To evaluate patients' satisfaction with a psychiatric day hospital in the West Galway Catchments area.

Study design: This is a cross-sectional study. Methods: This study was undertaken by using a 33-items questionnaire for 44 patients who attended the day hospital. SPSS version-12 was used for collecting and applying tests to the data, Fisher's exact test was used to analyse the data as sample size is small and P<0.05 was considered statistically significant. Results are also presented in the form of descriptive analysis including percentages and frequencies.

Results: Only 37 out of the 44 patients returned the questionnaires. Among the participants were 61% (n=22) male and 38% (n=15) female. The patients were mostly satisfied with the services available at the day hospital, except the waiting period for a first appointment. There was no significant (P=0.11) gender difference in terms of patients' satisfaction with the day hospital service. The age group, 45 years and above, were less satisfied (P=0.02) with the availability of a comfortable room for counselling, as compared to the younger age group. The patients did not like to tell others that they were attending the day hospital. The results were comparable with previous published patient satisfaction surveys using the same questionnaire by the Health Research Board, except that the patients in the present survey were more satisfied with the waiting area and availability of counselling.

Conclusions: Patients are mostly satisfied with the West Galway day hospital services.

The older patients (45 years and above) are not satisfied with the counselling room, and therefore further investigations are needed to ascertain their requirements for a counselling room. Patients are more satisfied with the waiting area and availability of counselling compared to the findings of other similar studies conducted in Ireland. Resources are needed to be allocated to the day hospital services.

Legislation governing committal practice has been a cause of controversy worldwide. A review of the relevant literature highlights the ongoing debate between those advocating broadly based ‘need for treatment’ criteria as a basis for committal (‘Parens Patriae’), and those who advocate more narrowly defined criteria requiring evidence of ‘dangerousness’ to validate committal. Current committal law in Ireland follows the ‘Parens Patriae’ tradition. However the recently published Green Paper on Mental Health points out that the current law is not compatible with international obligations, making reform inevitable. The Green Paper suggests various alterations in relation to committal criteria and procedures, with the retention of both ‘need for treatment’ as well as ‘dangerousness’ as valid committal criteria. These changes appear to be compatible with the ‘Stone criteria’ adopted as a model committal law by the American Psychiatric Association.

Objectives: In Ireland elderly patients with behavioural and psychological symptoms of dementia (BPSD) are frequently prescribed anti-psychotic and other psychotropic agents. Elderly patients with dementia are more sensitive to adverse effects of medications. Despite this, little is known of the psychotropic prescribing practice of psychiatrists who treat this population. General adult psychiatrists in the Republic of Ireland continue to treat elderly patients with BPSD. The aim of this audit was to identify the prescribing practice of general adult psychiatrists in elderly patients with BPSD. We compare this practice to that of old age psychiatrists in the UK and that recommended by the American Psychiatric Association in 1997.

Methods: We devised a structured anonymous questionnaire, which was forwarded to all general adult psychiatrists in the Republic of Ireland.

Results: Atypical anti-psychotics are frequently prescribed by general adult psychiatrists to manage BPSD in elderly patients. The anti-psychotic agent of first preference chosen to treat psychotic symptoms in dementia is risperidone. Overall, sedative typical anti-psychotics are still the most frequently chosen anti-psychotic agents, chosen to manage behavioural symptoms in dementia. Benzodiazepines and trazadone are the most frequently prescribed other psychotropic agents chosen to manage agitated behaviour. In general the median doses of antipsychotics and other psychotropic medication used are in keeping with both the APA guidelines and practice of old age psychiatrists in the UK. A minority of practitioners (10%) specified at least one dosage regime that was grossly outside recommended ranges.

Conclusions: Overall, prescribing practice in terms of choice of treatment and dosage regime, of general adult psychiatrists in BPSD is in keeping with the best practice guidelines. However, sedating typical anti-psychotics and on occasion extraordinarily high doses of anti-psychotics are still prescribed.

Objectives: To update the 20 year-old maxim that the majority of patients who undertake self-poisoning have recently seen their general practitioner, and to determine the patients' expressed reasons for consulting the doctor.

Methods: Two-stage cross-sectional survey: first, to find out from all self-poisoning patients whether they had recently attended their general practitioner; second, to determine, in a sub-sample of those who had attended, why they made their most recent consultation. The subjects were consecutive adult patients who were admitted to the general hospital in the City of Bradford as a consequence of self-poisoning.

Results: Overall 125/237 (53%) patients reported a consultation with their general practitioner in the previous month, and 61 of the 237 (26%) were within the last week. Patients recounted that their main expectations when consulting were to do with prescriptions, sick-notes and physical check-ups.

Conclusions: Although many of those who undertake self-poisoning consult their general practitioner shortly beforehand, a preponderance of physical complaints may render anticipation of the self-poisoning a difficult task.

Objectives: The Mental Health Act (MHA) 2001 provides the legislative structure in Ireland for the involuntary admission and treatment, including with ECT, of patients suffering from mental disorders. A recent Seanad Bill proposed removing the option of administering ECT to involuntary patients who do not provide informed consent. This controversial issue has stimulated extensive media and stakeholder debate. In this study we explored the attitudes of consultant psychiatrists towards prescribing ECT for involuntary patients.

Methods: We compiled a current list of consultant psychiatrists attached to approved centres nationwide. We sent a study specific questionnaire to consultants of all adult psychiatry specialties.

Results: From the 249 individualised anonymous questionnaires posted, 164 (66%) were returned and analysed. When clinically indicated for involuntary patients willing to consent to ECT treatment, 159 (97%) consultants stated that they would and three (2%) would not prescribe ECT. For involuntary patients who lack capacity and are unable to consent, 157 (96%) consultant psychiatrists stated that they would and six (4%) that they would not prescribe ECT. For involuntary patients who have capacity to consent but are unwilling to do so, 52 (32%) consultant psychiatrists stated they would and 104 (63%) would not prescribe ECT.

Conclusions: The overwhelming majority of consultant psychiatrists would prescribe ECT for involuntary patients who are unable to consent to this treatment. Divergent attitudes emerged for treating patients who are unwilling to consent, with most consultant psychiatrists stating they would not prescribe ECT for this patient group.

Objectives: Dual diagnosis refers to co-occurring substance use and psychiatric disorders. The principal aims of this investigation were two-fold: 1) to identify aspects of patients' drug use and prior treatment histories associated with their receiving a dual diagnosis upon admission to the Donwood Institute, a residential drug treatment facility located in Toronto, Canada; 2) to track temporal trends in the rates of diagnosed comorbidities over a five-year period at this same institution.

Methods: We conducted an analysis of the intake assessment forms and hospital records of 159 patients who had been admitted to a drug treatment facility during the month of September for each of the years between 1998 and 2002 inclusive. Comparisons were made between patients who had received a psychiatric diagnosis on admission and patients who had received no such diagnosis. We then employed logistic regression analyses to explore the relationship of the variable psychiatric diagnosis on admission to other patient variables.

Results: Among the patients studied in our sample, those receiving psychotherapy or taking prescription psychotropic medication at the time of their admission as well as patients whose primary problem substance was cannabis or who had been previously admitted to the treatment facility were significantly more likely to have received a psychiatric diagnosis on admission, in spite of our finding that several patients receiving psychotherapy or taking at least one psychotropic medication did not receive a psychiatric diagnosis on admission.

Conclusions: Whilst our data indicate that psychiatric comorbidity is common among individuals in treatment for substance use disorders at the Donwood Institute, it is possible that some individuals with psychiatric illness in our sample were not diagnosed as such when presenting for treatment of their substance use difficulties. Moreover, temporal tracking of rates of dual diagnoses did not reveal a consistent increase during the period studied.

Objectives: Despite their potential importance in affecting interactions between doctors and patients, there have been few attempts to measure attitudes to doctors and medicine. One scale, developed by Marteau, had shown a promising factor structure in a UK antenatal setting. The present study assessed its characteristics in Dublin general practice attenders.

Method: Patients aged over 16 waiting for a self-initiated consultation were recruited. The Attitudes to Doctors and Medicine Scale was administered by interview. Item analysis and factor analysis were used to examine its psychometric properties.

Results: Of 200 respondents, with a median age of 31, 144 were women. Item analysis showed lower reliabilities for the subscales of Marteau's scale than the original UK study, especially the subscales measuring negative attitudes to doctors and to medicine. Factor analysis failed to confirm a clear-cut distinction between attitudes to doctors and attitudes to medicine, and between positive and negative attitudes. Furthermore, factors which loaded in opposite directions in the original UK study loaded in the same direction in the Irish sample.

Conclusions: The differences found may reflect the differences either in culture or setting between the two studies. They strongly suggest that the Attitudes to Doctors and Medicine Scale does not have desirable psychometric properties. They also underline the need for a reliable and valid measure of attitudes to doctors and medicine, and for a more serious research interest in the area.

Objectives: To evaluate the self-rated or subjective quality of life of individuals with schizophrenia in residential care settings.

Method: Forty individuals who fulfilled DSM-IV criteria for schizophrenia were interviewed using the Lancashire Quality of Life Profile.

Results: Fifty-two per cent of the sample reported their global subjective quality of life to be satisfactory. Global subjective quality of life was rated lower than the majority of life domains evaluated. The areas of least satisfaction included finances and work. However, the majority of patients were satisfied with their living situation, safety, health, religion, leisure, social and family relations. There was some evidence of a quality of life gradient across these residential settings.

Conclusions: Although these patients were satisfied with the majority of life domains assessed, these data need to be interpreted cautiously given the limitations of the study design and the method used to evaluate quality of life.

The COVID-19 pandemic presents unique challenges to high quality, safe Early Intervention in Psychosis (EIP) service provision. Due to the necessity to ensure EIP continues despite this, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of first episode psychosis service users: PERCEPTION. This perspective article aims to: describe PERCEPTION; offer reflections on our experience of delivering it; make recommendations for future research; and synthesise key learning to assist the integration of similar interventions in other EIP services. We provide a descriptive account of PERCEPTION’s development and implementation, with reflections from the clinicians involved, on supporting families using this approach. We experienced telehealth as patient-focused, safe, and efficient and believe the intervention’s blended nature augmented families’ engagement. The approach adopted can assist service providers to attain balance between protecting public health and offering a meaningful, therapeutic intervention to support families in the current epoch.