A 21 year-old woman with Prader-Willi syndrome (PWS) and a delusional disorder (paranoid psychosis) is described. Other reports of psychoses associated with PWS are reviewed. Reasons for the co-existence of the two disorders are considered, with discussion of the possible role of auditory information processing deficits in the genesis of psychotic symptoms. Such symptoms must be differentiated from maladaptive behaviours not arising from psychosis, the latter being relatively common in PWS. Treatment with a small dose of flupenthixol greatly reduced the impact of the patient's psychotic symptoms, with a corresponding improvement in her quality of life.

Objectives: The hypothesis that burnout is predictive of performance deficits on a number of neuropsychological tests was examined among a group of psychiatric nurses. A possible relationship between burnout and state and trait anxiety levels was also investigated.

Methods: A sample of psychiatric nurses (n=45) completed the Maslach Burnout Inventory (MBI) and the State-Trait Anxiety Inventory (STAI). Their performance on a number of neurocognitive tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) was examined. The neurocognitive tests measured visual memory, verbal memory and attention.

Results: Multiple regression analyses were conducted between the burnout subscales and the results of the neuropsychological tests, and also between the burnout subscales and both state and trait anxiety levels. No overall significant relationship was found between neurocognitive performance and burnout. However, trait anxiety was significantly predictive of each of the burnout subscales of emotional exhaustion, depersonalisation and also of decreased personal accomplishment.

Conclusions: The levels of burnout were in the moderate range for all three subscales and so the population was suffering from burnout. The fact that the trait anxiety variable was predictive of all three of the burnout subscales suggests that predisposition towards anxiety may be a vulnerability factor among people who suffer from burnout.

Objectives: This study assessed self-reported prospective memory and related central executive processes in a group of excessive alcohol users and non-users. The aim was to assess whether excessive alcohol use is associated with impairments in these two sets of memory processes.

Methods: Eighty participants from the North-East of England were tested. Of these, 40 were excessive alcohol users (using above the recommended weekly ‘safe’ dose of alcohol) and 40 were low-dose/non-users. Each participant was assessed using self-reports of prospective memory (PM) – measured using the Prospective Memory Questionnaire (PMQ) and central executive (CE) processes – measured using the Dysexecutive Questionnaire (DEX). Other drug use, age and strategy use were incorporated into the study as controls.

Results: After controlling for other drug use, age, and strategy use, excessive alcohol users reported global impairments in everyday prospective memory and in their central executive processes, when compared to a low-dose/no-alcohol control group.

Conclusions: These findings suggest that excessive alcohol use has a detrimental impact upon everyday memory – a relatively unexplored area of research. PM and CE deficits should be added to the growing list of neuropsychological sequelae associated with chronic excessive alcohol use.

Objectives: There have been concerns in the international literature that the manner in which psychiatry and psychiatric patients is portrayed in the print media is negative and sensational. If correct this has serious implications for the stigma and prejudice that our patients will suffer. This study was designed to evaluate the content and tone of articles relating to psychiatry. It was compared with a broadly similar study published in 1995 and will form the base from which to measure changes in psychiatric coverage over time.

Method: All the daily broadsheets, one daily tabloid and three Sunday broadsheets were examined for a six month period in 1999 and all articles, letters or headlines incorporating psychiatry-related material were examined. Using specific definitions, articles and headlines were examined for tone and content as well as for the contribution of mental health professionals.

Results: Overall 0.65 articles per newspaper per day were found. News items and feature predominated, with forensic issues receiving the greatest attention. The tone of the articles was either neutral or positive and the improvement in the tone of articles in the tabloids was particularly noticeable when compared with an earlier study. This is very different from the findings of international studies. However, the headlines were more sensational in tone than the contents of the articles themselves. Increasingly the opinion of health professionals was sought but contributions from psychiatrists remained low, writing just two articles and constituting 15% of health professionals whose opinions were sought. Nine per cent of items constituted misuse of terms.

Conclusions: The Irish print media are not hostile to psychiatry and there has been an improvement in tone and type of article in the past five years. Greater involvement of psychiatrists in the media and particularly more direct engagement with editors is required if there is to be a shift from coverage of forensic matters in favour of informative articles as well as improvement in the headline tone.

Objective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.

Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.

Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.

Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.

A pilot study of the effects of early intervention by a multidisciplinary community team in patients presenting as psychiatric emergencies to an inner London teaching hospital (St. Mary's) is described. Of 22 consecutive emergency referrals, 20 agreed to be formally assessed, 18 were successfully engaged and 16 had assessments of symptoms and social functioning assessed over a four week period. There was significant improvement in clinical symptoms but no important changes in social functioning. The discordance between improvement in social function and symptoms was unexpected and may reflect the unusual social circumstances of life in metropolitan London or be a consequence of the high proportion (55%) of patients seen with personality disorders.

The psychedelic research renaissance is gaining traction. Preliminary clinical studies of the hallucinogenic fungi, psilocybin, with psychological support, have indicated improvements in mood, anxiety and quality of life. A seminal, open-label study demonstrated marked reductions in depression symptoms in participants with treatment-resistant depression (TRD). The associated neurobiological processes involve alterations in brain connectivity, together with altered amygdala and default mode network activity. At the cellular level, psychedelics promote synaptogenesis and neural plasticity. Prompted by the promising preliminary studies, a randomized, double-blind trial has recently been launched across Europe and North America to investigate the efficacy of psilocybin in TRD. One of these centres is based in Ireland – CHO Area 7 and Tallaght University Hospital. The outcome of this trial will determine whether psilocybin with psychological support will successfully translate into the psychiatric clinic for the benefit of patients.

In 1960, Thomas Szasz published The Myth of Mental Illness, arguing that mental illness was a harmful myth without a demonstrated basis in biological pathology and with the potential to damage current conceptions of human responsibility. Szasz's arguments have provoked considerable controversy over the past five decades. This paper marks the 50th anniversary of The Myth of Mental Illness by providing commentaries on its contemporary relevance from the perspectives of a range of stakeholders, including a consultant psychiatrist, psychiatric patient, professor of philosophy and mental health, a specialist registrar in psychiatry, and a lecturer in psychiatry. This paper also includes responses by Professor Thomas Szasz.

Szasz's arguments contain echoes of positivism, Cartesian dualism, and Enlightenment philosophy, and point to a genuine complexity at the heart of contemporary psychiatric taxonomy: how is ‘mental illness’ to be defined? And by whom? The basis of Szasz's doubts about the similarities between mental and physical illnesses remain apparent today, but it remains equally apparent that a failure to describe a biological basis for mental illness does not mean there is none (eg. consider the position of epilepsy, prior to the electroencephalogram). Psychiatry would probably be different today if The Myth of Mental Illness had not been written, but possibly not in the ways that Szasz might imagine: does the relentless incarceration of individuals with ‘mental illness’ in the world's prisons represent the logical culmination of Szaszian thought?

In response, Professor Szasz emphasises his views that “mental illness” differs fundamentally from physical illness, and that the principal habits the term ‘mental illness’ involves are stigmatisation, deprivation of liberty (civil commitment) and deprivation of the right to trial for alleged criminal conduct (the insanity defence). He links the incarceration of the mentally ill with the policy of de-institutionalisation (which he opposes) and states that, in his view, the only limitation his work imposes on human activities are limitations on practices which are conventionally and conveniently labelled ‘psychiatric abuses’.

Clearly, there remains a diversity of views about the merits of Szasz's arguments, but there is little diminution in his ability to provoke an argument.

Objective: To compare the perceived accuracy of diagnostic information derived from psychiatric patients and a range of other informants using a schedule for assessing personality disorders (Personality Assessment Schedule). Method: The Personality Assessment Schedule includes a rating of reliability of the information obtained from whatever source. A record was made of these reliability scores in 405 patients with psychiatric disorder; 146 with both subjects and other informants and 259 with the informant only, and analysed using non-parametric statistics. Results: There was significant variation in the distribution of scores among the four psychiatrists who rated 232 of the interviews with informants, suggesting that inter-individual differences are paramount in deciding who is a reliable informant. Nevertheless, the views of other informants when they were spouses or cohabitees were judged to be more accurate than those of other relatives or acquaintances. No differences were found in the perceived reliability of data from subjects and informants when both were interviewed separately. Conclusions: Subjects and informants are judged to be equally reliable in giving assessments of personality status but the informants who have the closest relationship to subjects, spouses and cohabitees, are judged superior to informants of more distant immediate relationship in the accuracy of their information about personality status.

Objective: We sought to establish the views of general practitioners about detecting and managing patients with a first episode of schizophrenia in Ireland.

Method: Twenty per cent of GPs were invited to participate in a cross-sectional postal survey.

Results: Sixty-two per cent (n = 261) participated. Almost all (99.2%) see at least one case of suspected first episode schizophrenia annually. The most commonly (80.7%) encountered symptom is ‘bizarre behaviour’. Many (47.7%) rarely or never prescribe antipsychotics to patients whom they suspect have a first episode of schizophrenia. However, 80.6% of GPs reported that they ‘always’ refer this group of patients to psychiatric services. Over half (57.8%) advised patients with schizophrenia to continue medication for less than a year. A large number of respondents reported that it is difficult to obtain a rapid psychiatric assessment.

Conclusions: GPs want more information about identifying early psychosis, a closer liaison with psychiatric services and a rapid intervention service.

The coronavirus crisis occurs at a time when many clinicians have already experienced burnout. One in three Irish doctors were suffering from burnout in the 2019 National Study of Wellbeing of Hospital Doctors in Ireland; rates are also high in Irish Psychiatry. We present a perspective on the use of narrative in medicine and recognise that storytelling, and the patient history are very much at the heart of medicine. Clinician storytelling, such as Schwartz Rounds and Balint group work, has very much come to the fore in Irish Psychiatry and in training. Projects such as MindReading have explored overlaps between clinicians, humanities experts and experts by experience. We give an overview of some approaches from the movement around narrative in medicine to bolster this. We explore why clinicians write as ways to support identification, catharsis and a way to process experiences. Clinicians and patients may also use literature and poetry to promote coping. The historical context and practical strategies are highlighted, particularly with reference to poetry use during the current crisis.

Objective: General practitioners play a crucial role in the delivery of psychiatric treatment to patients who have many similarities to those attending the general psychiatric services. The purpose of this study was to elicit attitudes of general practitioners to an existing local service. Methods: We used an anonymous questionaire hand delivered to 54 general practitioners with practices in the catchment area of one of Dublin's psychiatric hospitals. Results: We received responses from 40 of the GP's indicating a high level of psychiatric morbidity in the primary care setting, a moderate level of satisfaction with psychiatric service, a low level of knowledge of the catchment area system, limited interest in taking on an increased role in the care of psychiatric patients and a high popularity rating for the community psychiatric nurse. Conclusions: This study confirms previous estimates of psychiatric morbidity in general practice, a need for improved communication between psychiatrists and general practitioners to identify more realistic expectations on both sides of the equation, and a huge potential for the expanding community psychiatric services to improve liaison between general practitioners and psychiatrists and yield considerable patient and doctor gains.

Objectives: The rate of suicide among young men is rising. However, young men are reluctant to use mental health services. In this study we explored young men's attitudes towards mental illness and mental health services, as well as their willingness to use these services.

Methods: Four focus groups were conducted in two Dublin schools. A total of 18 students participated in the study.

Results: Students held negative views towards mental health services, particularly in respect to psychiatric hospitals and medication. Students were not well informed about whom to contact if they had depression and were very conscious about the stigma of going to see a ‘professional’. Many students did not recognise depression as being a mental illness and could not differentiate between depression and feeling sad.

Conclusions: This study shows that a lack of knowledge and understanding about mental illness, combined with prejudice against mental health professionals and fear of stigma, are important barriers to access of mental health services for young men.