Objective: The repeated, self-inflicted, non-accidental injury known as Self Injurious Behaviour (SIB) is a cause of severe stress to carers and a challenge to multi-disciplinary teams working with people with a mental handicap. A need for Irish data on this problem was answered by collecting a representative cohort and following its members up to record the prevalence of SIB.

Method: The group studied included all people with an IQ of less than 50 (that is those in the moderate, profound and severe range of intellectual ability) whose place of origin was within the geographical borders of a single community care area. Following a preliminary tracing process, each person was followed up for one calendar month using a specifically prepared format to record daily occurrence of SIB.

Results: The group resulting from the tracing process consisted of 429 people (= 0.4% of the total population), 62 (=14 %) of this group exhibited SIB, during the time of the study. Of the demographic variables studied SIB was found to be related to IQ. Of those who self-injured those who showed multiple topographies and those who showed the greatest frequency of SIB were more likely to be found in the population who lived in a residential facility.

Conclusions: SIB is related to IQ but in a non-linear way suggesting that factors other than IQ militate against more severely handicapped people displaying this behaviour. SIB is not caused by living in a residential centre however our results suggest that living in a residential facility is the result of displaying SIB. This study suggests that implications for future treatment approaches and service provision for those exhibiting SIB in Ireland can be made with reference to research from other countries.

Novel coronavirus 2019 (COVID-19) has shaken the existence of mankind worldwide, including that of New Zealand. In comparison to other countries, New Zealand has had a very low number of confirmed and probable cases as well as COVID-19-related deaths. New Zealand closed its borders and rapidly declared a stringent lockdown to eliminate COVID-19. The country’s ‘go hard, go early’ policy serves as an exemplar for the rest of the world to date. The mysterious nature of COVID-19 has caused tremendous stress and uncertainty leading to universal conflict between public health and state economy. Mental health services and non-government organisations have been proactive in the fight against COVID-19. Though there has been no significant rise in referrals to secondary mental health services to date (4 May 2020), a rapid surge in mental health presentations is widely anticipated. Telehealth may prove to be an efficient and cost-effective tool for the provision of future health services.

Objective: To determine the prevalence of dementia in an Irish sample of Down's syndrome (DS) patients and to examine the utility of a number of cognitive and functional scales in the assessment of dementia in this population.

Method: 76 DS patients diagnosed clinically (range 33–72 years; mean age 47.3 ± 8.8 years) were included in the study. The diagnosis of dementia was made on clinical grounds using DSMIIIR criteria. Cognitive and functional impairment were evaluated using the following scales; Test for Severe Impairment (TSI), Down's Syndrome Mental Status Examination (DSMSE), Daily Living Skills Questionnaire (DLSQ), and the Mental State Performance (MSP).

Results: The overall prevalence of dementia was 7.9% (95% C.I = 2.95–16.39). The presence of dementia was associated with late onset epilepsy, anticonvulsant medication and deafness. Standard cognitive tests such as the MSP showed an early ‘floor’ effect in this population. In contrast the TSI and DLSQ showed a satisfactory range of scores in these patients with moderate to severe learning disability.

Conclusions: The low prevalence of dementia in this study may be explained by the strict conservative criteria applied in the clinical diagnosis. Prospective assessment of DS patients on a longitudinal basis using decline on scales such as the TSI and DLSQ may allow more accurate diagnosis of dementia at an earlier stage in this at-risk population.

Aims: To identify and describe the context and factors involved in the opioid lapse process following discharge from an Irish inpatient opioid detoxification treatment programme.

Design, participants, setting: Prospective follow-up study of consecutive detoxified opioid dependent patients treated in a specialist inpatient drug dependency unit.

Measurements: The Maudsley Addiction Profile and a structured interview were administered to 109 patients, 18–36 months after discharge.

Findings: Of 109 people interviewed at follow-up, 102 (94%) reported at least one episode of opioid use after leaving the residential treatment programme. Eighty eight patients (86% of the lapsers) identified more than one major factor contributing to their recidivism. The median number of factors identified as having a major role in the lapse was four. The most frequently reported major contributors to lapse were low mood (62%), difficulties with craving (62%), ease of access to heroin (48%) and missing the support of the treatment centre (43%).

Conclusions: Early lapse was common following inpatient treatment of opioid dependence. Lapse tended to result from a number of common, identifiable, high-risk situations, feelings and cognitions which may assist clinicians and patients develop lapse prevention strategies to anticipate and interrupt this process.

Objectives: The aim of this study was to examine and describe levels of psychological health and well-being in a group of young people living in Dublin.

Method: A sample of 97 young people (50 males, 47 females) were assessed for psychological status, suicidal ideation, substance misuse, contact with the law, self-esteem and locus of control as well as various social indicators such as educational attainment and social connectedness. A screening version of the Structured Clinical Interview for DSM-IV Axis Diagnosis (SCID) was used to assess psychological functioning and the Beck Scale for Suicide Ideation was employed to ascertain suicidal ideation. Self-esteem was measured using the Rosenberg Self-Esteem Scale and locus of control was measured using a scale devised by Pearlin, Menaghan, Lieberman and Mullan (1981).

Results: Symptom levels were high and approximately one fifth of respondents had a probable psychiatric condition (most commonly depression or anxiety). Yet, only a small percentage was receiving treatment for psychiatric difficulties. Over half of the participants had used nonprescription drugs at some time. Alcohol consumption was high, especially amongst male respondents. Over half of those interviewed were categorised as misusing alcohol and/or drugs and participants greatly underestimated their level of alcohol use. Approximately one-quarter had had some contact with the law which was related to deficits in educational attainment and the latter variable was associated with childhood economic disadvantage.

Conclusions: These findings suggest that among a sample of 97 young Irish people, a high level of psychiatric symptomatology and excessive use of alcohol is evident. This remains largely untreated as only a small percentage of the group had sought help for psychological difficulties which suggests a need to address the issues of mental health awareness, alcohol use and the accessibility of services. The paper also underlines the association between economic disadvantage and lack of educational attainment with associated linkages to offending.

Vulnerable groups are often excluded from clinical research on the basis of scientific, ethical and practical reasons. Although intended to protect vulnerable people and maintain study integrity, exclusion of vulnerable groups from research through use of standard exclusion criteria may not always be necessary and may result in findings that are not generalisable. Achieving a balance between the competing needs to protect vulnerable people and to make progress in our understanding of disorders and their management through research requires a reconsideration of exclusion criteria and consent processes to ensure vulnerable people are appropriately represented in clinical research. Reasons for development of broad exclusion criteria include both concrete barriers and intangible discouraging factors. This paper examines this situation and its consequences, perceived and real barriers to inclusion of vulnerable people in research, and suggests methods for overcoming these barriers and applying thoughtful exclusion criteria.

It is 20 years since the first references to elder abuse appeared in the medical literature. Since then there h as been a growing realisation that although most elderly people are cherished by their families a substantial minority are at risk of abuse. Prevalence studies in different countries have suggested that approximately 5% of those over 65 may be subjected to various forms of abuse including physical, verbal, financial abuse and neglect.

Objectives: To determine the attitudes and experiences of nursing staff in relation to violent and aggressive patients.

Method: A self-administered questionnaire booklet was distributed to 289 nursing staff working in ‘high-risk’ units within two NHS Trusts. In addition to assessing the frequency of violent incidents, the degree of burnout and post-traumatic symptoms experienced were assessed by the inclusion of two standardised measures in the survey, viz, the Maslach Burnout Inventory and the Impact of Event Scale-Revised respectively.

Results: One hundred and fifty six (54%) nurses responded to this survey. Over two-thirds of nurses (72%) had been physically assaulted during the previous two years. The longterm psychological impact of these incidents was not related to whether or not a physical injury was sustained. A positive correlation between burnout and exposure to verbal abuse, threatened assault and violence was demonstrated.

Conclusions: Nurses in these Trusts are exposed to an unacceptable level of violence or aggression from patients, potential implications of which include post-traumatic reactions and burnout. However, nurses are reluctant to report incidents of verbal abuse or threats formally, and they rely upon the support of their colleagues following ‘distressing’ incidents. To protect the wellbeing of their staff, hospital management needs to consider preventative measures, such as training and personal alarms, and improved reporting systems to ensure all incidents are accurately recorded.

Objectives: An increasing number of research studies support the benefits of providing music therapy in addition to standard treatment for people who have mental disorders. The objective of this paper was to review and summarise recent research findings in relation to this work.

Method: A review of music therapy studies published since 1994 was undertaken. Criteria for including papers were that they a) were published in English in an indexed, peer-reviewed journal, and b) were conducted as a randomised controlled trial (RCT) or a controlled trial (CT), or c) provided a meta-analysis of existing studies. The large number of papers pertaining to music therapy for older adults who have mental disorders, including Alzheimer's disease and other types of dementia was not included.

Results: The findings support a role for music therapy as a structured interaction that patients are able to use to participate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music therapy is demonstrated to be a beneficial intervention for people who have enduring mental illness. Music therapy invites and encourages participation from people of lower functioning levels and employs a non-verbal medium with which people have prior positive associations and in most cases have lifelong experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.

Conclusions: Music therapy is beneficial for patients receiving care for mental disorders and establishing this therapy within mental health service provision should be considered.

When children under five years of age are assessed and investigated following an accidental injury or self-poisoning, the possibility of psychiatric disorder and indeed suicidal intent is rarely considered. We present a case of repeated self-induced poisonings in a five year old boy, who on psychiatric examination demonstrated serious psychopathology and expressed ambivalence in relation to suicidality. All such presentations should receive consideration as to whether a referral to child psychiatry is indicated. In the training of general practitioners, paediatricians and psychiatrists alike, attention should be given to this area.

Objectives: Magnetic Resonance Imaging (MRI) has been used to assist the diagnosis of Alzheimer's Disease (AD) in adults with Down's syndrome (DS). However, the interpretation of the scans is difficult and clinical usefulness is uncertain. We aimed to summarise the current knowledge of MRI studies in adults with Down's syndrome with and without dementia and to discuss its implications for clinical practice.

Method: We identified MRI studies in DS by a computerised literature search with Medline, Embase, and Psychlit from 1986 to 2001. We examined the references of identified articles and hand searched relevant journals. Structural MRI studies were selected as this type of imaging is most frequently used in clinical practice.

Results: We included eight volumetric studies in adults with DS. Four of these included adults with DS and dementia. Overall, the size of brain structures such as cerebellum, hippocampus and cortex of adults with DS without dementia was significantly smaller than in normal controls. The basal ganglia were similar in size, and ventricles were enlarged. Furthermore, the size of brain structures in adults with DS and dementia was significantly different than in DS without dementia. In particular, ventricular and hippocampal volumes were affected.

Conclusions: The change in brain structure associated with dementia can be detected on MRI of adults with DS. However, these may be difficult to interpret given the extent to which brain appearance in DS differs from that in the general population. Implications for clinical practice and future research directions are discussed.