“The idea of a psychotherapeutically informed psychiatry seems such a simple and obvious one and yet the divide between psychotherapy and general psychiatry – between ‘brainlessness’ and ‘mindlessness’ has, until recently, seemed unbridgeable”.

The Psychotherapy section of the Royal College of Psychiatrists has the largest membership in the college. Since psychotherapy became recognised as a discipline within psychiatry in 1975 the Royal College of Psychiatrists has recommended one consultant psychotherapist for each 200,000 of the population. In Northern Ireland there are only 1.9 whole time equivalents rather than the eight expected and in the Republic of Ireland there is none. According to the recent document produced by the Royal College of Psychiatrists' Psychotherapy Faculty Executive Committee in December 1998, The development of psychological therapy services: Role of the consultant psychotherapist, there has been no net growth in the last five years in the numbers of psychotherapists in England and Wales. The future looks equally gloomy in Ireland.

This is rather surprising given that recent government documents have highlighted both the importance and the effectiveness of psychological therapies. There is a growing evidence base underpinning the use of psychotherapy in the management of a wide variety of conditions including psychoses, eating disorders and severe personality disorders.

Psychotherapy has high public acceptability and finds itself in the unusual position of having both government and public demanding the provision of extra psychological therapies, but not receiving the full support of psychiatry and the purchasers of healthcare.

Objectives: Changes in healthcare policy over the last decade emphasise care in the community over residential care. Self-help organisations may play a useful role in these circumstances. Against this background, the objective of this study was to obtain the views of members of the main mental health professions on the place of self-help groups in mental health care.

Method: A postal survey of 255 mental health professionals from two health boards was carried out, using a semi-structured questionnaire that contained both open and closed questions. The responses obtained were analysed using descriptive statistics and content analysis as appropriate.

Results: The response rate was 35% so results must be interpreted cautiously. Self-help groups are used particularly in the management of addictive behaviours, and are also considered useful in cases of mood disorder. In general, self-help organisations are seen as providing support to patients and their families; information on mental illness/health to the general public; and lobbying for services relevant to the needs of their members. Respondents were concerned that the philosophy and programme of a group should not conflict with established models of mental health. The impact of the organisational structure of the multi-disciplinary team on the referral pattern of the different mental health professions, and the role of group availability and accessibility on the decision to refer a patient to a self-help group is commented upon.

Conclusions: While some professionals see a role for self-help organisations in the mental health care system, reservations expressed about a possible clash between selfhelp groups' approach and professional mental healthcare practice need to be addressed so that the potential of both positions can be realised.

Objectives: To evaluate the sensitivity of the CAMCOG naming subscale to anomia in Alzheimer's disease (AD) patients identified as anomic on the Boston Naming Test (BNT); and to compare the sensitivities of BNT, category (semantic) fluency (CF), and episodic memory (Delayed Word Recall, DWR) in detecting AD.

Method: Data from 140 probable AD patients (NINCDS/ADRDA) were analysed. Anomic AD patients were identified (BNT) and the sensitivity to anomia of the CAMCOG naming subscale was calculated. Sensitivity (to AD) and specificity of the BNT, CF and DWR were compared in a subgroup of 60 patients age-matched to controls.

Results: On BNT 81% of ADs were classified as anomic (87% specificity). Of these anomic ADs, 23 scored 6/6 on CAMCOG naming (sensitivity = 80%), and sensitivity fell to 30% using a 5/6 cut-off. Correlation between BNT and CAMCOG naming yielded Kendall's tau = 0.48 (p<0.0001). Compared to age-matched controls BNT correctly classified 70% of ADs and 87% of controls (overall accuracy = 77%). On CF 68% of ADs and 83% of controls were correctly classified (overall accuracy = 72%). BNT and CF were moderately correlated (r = 0.49, p<0.0001). DWR correctly classified 93% ADs and 98% controls (overall accuracy = 95%).

Conclusions: Given its brevity, we recommend the inclusion of a split-half form of the BNT in screening test batteries for the detection of AD. The observed pattern of cognitive impairment is consistent with current models in which semantic memory deficits occur in AD only when the neuropathology extends beyond the entorhinal/hippocampal region to the temporal neocortex.

Objectives: The purpose of the study was to define various aspects of epilepsy in a population based sample of adults with a learning disability.

Method: A purpose-designed questionnaire was used to collect information on various aspects of epilepsy on 143 adults with a learning disability and epilepsy. Names of these subjects were collected from a hospital for learning disabled adults, specialist epilepsy clinics and social services department. Data was gathered from case notes and direct patient examination.

Results: Generalised tonic clonic seizure was the most common seizure type. Seventy-three per cent sustained a seizure within the previous 12 months of the study. Abnormal EEG findings including excessive slow background activities and epileptiform waves were documented in a high proportion of subjects with a learning disability and epilepsy.

Conclusions: Both resistant epilepsy and generalised tonic clonic seizures seem to be more frequent among the learning disabled population compared with the general population.

Objectives: To identify whether a simple marker of nonpsychiatric health service contact (weight of general hospital case notes) is helpfulin identifying patients with evidence of psychiatric disorder in a medical and surgical population.

Method: Hospital case note review identifying evidence of past and current psychiatric disorder in patients with heavy, medium and low weight case notes. Responses to letters to general practitioners and review of local psychiatric hospital records were used to validate findings. Setting: A large general teaching hospital in the centre of Leeds, UK. Subjects: Random sample of 240 patients aged 16-65 attending general hospital medical or surgical teams as an inpatient or day patient between April 1, 1991 and March 31, 1992. Patients whose index admission was to the gynaecology or obstetrics unit were excluded. Main outcomes: Non-psychiatric service contact was measured by case note weight and thickness, lifetime admissions and number of consultants seen. Psychiatric disorder was identified using global judgements based on a standardised assessment of the case notes, and also general practitioner statements of current or past psychiatric disorder and record of contact with psychiatric services.

Results: In a detailed examination of 75 cases, 92% of patients with lightweight notes had solely physical factors to account for their presentations, compared to 88% in the middleweight group and 64% in the heavyweight group. Heavier case notes more often contained comments about psychiatric problems affecting the physical presentation (lightweight 8%; middleweight 20%; heavyweight 64%). Patients with heavy case notes more often had a history of contact with psychiatric services as confirmed by the GP or contact at local psychiatric hospitals (lightweight 28% middleweight 24% heavyweight 48%). Amongst the heaviest service users, patients with a psychiatric problem had seen a median of 12.0 lifetime consultants compared to 8.5 in those where a purely physical cause was present.

Conclusions: Patients who have heavy hospital case notes are more likely to have evidence of psychiatric disorder than those with lower levels of hospital contact and this is more likely to have an impact on their physical presentation and clinical course as judged by case note review using structured assessment criteria.

Objectives: Literature reports on SSRI associated discontinuation symptoms are variable. As a result, the prevalence of an antidepressant halo effect can not be ruled out. This survey aims to assess the awareness and experience of these symptoms among doctors in Ireland.

Method: Questionnaires were sent to a random sample of 100 GPs, NCHDs and consultants. A questionnaire measured awareness, experience and reported severity, of SSRI discontinuation symptoms as opposed to TCAs, the latter being used as ‘controls’. Data was statistically analysed using SPSS (Windows Version 8.0).

Results: Response to the questionnaire was as follows: 37% of GPs (n = 37), 35% consultants (n = 35) and 18% NCHDs (n = 18). Comparisons were made between the three groups. There was significant variability in the reported recognition and severity of symptoms specific to the SSRI discontinuation syndrome within and between the groups. Overall NCHDs attribute less discontinuation symptoms to SSRIs (p = 0.038) and GPs attribute more to TCAs (p = 0.03).

Conclusions: Doctors tend to generalise discontinuation symptoms to all antidepressants with significant variation in reporting practices. Thus there is a need for randomised control studies to aid the recognition and prevention of the discontinuation syndrome.

Objectives: The establishment of a learning disabilities psychiatric service for people living in north Northamptonshire presented the opportunity to measure the clinical effectiveness of epilepsy care provided by learning disabilities psychiatrists.

Method: Baseline and one year outcome health measurements were made on a group of adults with learning disabilities and epilepsy who received learning disabilities psychiatric care (n = 42), and also on a group of adults with learning disabilities and epilepsy who did not receive care from learning disabilities psychiatry -(n = 12). Comparisons were made between baseline and outcome measurements for those who did, compared to those who did not receive psychiatric care. The comparison group was included as conducting a baseline health assessment may itself improve the quality of healthcare by raising awareness of the issue (in a way that is unconnected to care provided by the psychiatrist).

Results: Learning disabilities psychiatric care was found to effect reduced seizure frequency, with a reduced frequency of drug side-effects and reduced frequency of polypharmacy. The type of the person's seizures was more likely to be determined, medical reviews and appropriate blood test monitoring conducted and active interventions made to improve seizure control and to withdraw unnecessary drugs, if the person was receiving learning disabilities psychiatric care. Almost all of these results were highly statistically significant.

Conclusion: It is important that learning disabilities psychiatric care is available to this group, as it has been demonstrated to effect health gain.

Objectives: Renewed scientific and media interest in suicidal behaviour has resulted in a number of initiatives examining and defining this complex and tragic phenomenon. However, in comparison to the study of adult suicidal behaviour, that of adolescents is still under researched. This study aimed to identify the extent and nature of parasuicide in young people under 17 years of age in the Foyle area in the 28 month period up to and including April 1997.

Method: The psychiatric assessments of all those admitted to hospital as the result of parasuicide during this period were examined. A psychosocial and clinical profile of this group of young people was then constructed. Any reported stressors recorded in the assessments were noted, and an attempt was made to ‘track’ contact with helping agencies in each case during the months immediately before and after admission.

Results: One hundred and twenty four young people were admitted during the period under review, the vast majority following an overdose.

Conclusions: Family conflict, family illness and bullying were the three most frequently recorded stressors. Twothirds had no apparent contact with services in the three months prior to admission, and of these, half were not referred on to specialist services after they had been discharged from hospital.

Objectives: To establish suicide rates of psychiatric inpatients in Ireland and the characteristics, demographic, social and medical, of the patients involved.

Method: Clinical, post mortem and inquest data on all such deaths from 1983-1992 were examined. Suicide rates were calculated using ‘person year method’.

Results: The suicide rate for short stay inpatients (stay less than one year) was 319/100,000, and 118/100,000 for long stay patients. The average duration of illness at time of suicide was 10 years. A fourfold increase in suicide rate of inpatients over the century was associated with a similar increase in the suicide rate in the general population. Thirty five per cent of suicides were aged 25-34 years. The risk of suicide was higher the shorter the time interval after admission. Three quarters of suicide deaths in registered inpatients occurred away from hospital grounds.

Conclusions: Social factors which contribute to an increase in the suicide rate in the general population are relevant to the increase in hospital inpatient suicides. More effective and comprehensive services to meet the needs of those with severe mental illness, particularly young adults, are essential. The results emphasise the importance of managing inpatients in a safe, secure environment. The person year method is appropriate for monitoring changes in suicide rates.

Objectives: To describe an entire long-stay hospita population and examine the differences between the old and new long-stay groups. It outlines the communitybased facilities required for hospital closure to occur.

Method: One hundred and twenty-four patients were assessed using the Community Placement Questionnaire (CPQ), a standardised instrument used in service planning.

Results: The CPQ revealed a globally disabled group with multiple handicaps. The mean age was 68.7 years and the predominant diagnosis was schizophrenia. Though the old long-stay (74) were more disabled than the new long-stay (50), similar sheltered accommodation was required for both groups. The new long-stay required a more active day-care program.

Conclusions: Reprovision for long-stay patients must not only include sheltered accommodation but also appropriate day-care facilities. Assessment of the placement needs of all categories of long-stay patients necessary before hospital closure can take place.

Objectives: To describe forensic and clinical characteristics of unfit to plead defendants in Ireland between 1850 and 1995 as well as outcome in terms of length of stay in custody and ultimate disposal of cases. These data are compared with studies from the US and the UK. The White Paper on Mental Health (1995) highlights the need for significant change in the management of mentally ill defendants who come before the courts. The current criteria for the assessment of fitness to plead date from 1836. There has been little previous research on the use of fitness to plead procedures in Ireland which might guide future law reform.

Method: This is a retrospective study of demographic, forensic and clinical data on an almost complete sample of 488 unfit to plead patients admitted to the Central Mental Hospital between 1850 and 1995. A standardised profile was completed on each subject with data drawn from hospital records and entered onto a database for analysis.

Results: The use of the fitness to plead procedures peaked in the period 1910-20, and has fallen into substantial decline since then. Defendants were usually male, with a mean age of 37 years who had been charged with a violent crime. Three quarters of defendants were psychotic on admission. The mean length of detention was 14.3 years and only 4% were ultimately returned for trial.

Conclusions: The decline in the number of fitness to plead findings is probably related to the reluctance of defendants to use the procedure due to the resulting prolonged period of detention. The introduction of a formal judicial review procedure to reassess the appropriateness of detention is urgently required to protect the civil liberties of those found to be unfit to plead.

Objectives: To compare the electroconvulsive therapy response of a sample of depressed elderly patients as a function of the presence or absence of psychosis.

Method: Retrospective study of patients over age 65 treated with ECT at three psychiatric hospitals over a three year period.

Results: One hundred and eighty-nine ECT courses were administered to 135 patients. Almost 8 5% of patients made a marked or moderately good response to treatment. There was no difference in ECT response between psychotic and non-psychotic depressed patients.

Conclusions: ECT should be considered as a treatment option for severe depressive illness, regardless of depressive subtype.

Objectives: To ascertain whether or not there had been any improvement in the registration of deaths in Co. Mayo, Ireland, since 1970. At the time is was shown that 7.5% of deaths, in a sample of parishes in the west of Ireland had not been registered.

Method: A list of all those who died and were buried in Co. Mayo in 1992, was obtained and compared with a list of deaths registered in that and subsequent years.

Results: One hundred and twenty eight deaths (11.5%) occurring in the county in 1992 had not been registered by the time of this study in 1997.

Conclusions: Non-registration of deaths continues to pose serious problems for research and for the planning of health services. It is suggested that the government introduce legislation to address the issue. Registration of deaths should be standardised throughout the EU.

Objectives: This study explores the gender difference in patterns of drug use, risk behaviour, health and well-being among 934 new attenders at a Dublin syringe exchange.

Method: Over the period May 1997 to April 1998 data was collected by means of structured interviews with all clients who presented for the first time at Merchant's Quay health promotion unit. All information collected was based on clients' self-reported behaviour.

Results: Of the new clients, 24.3% were female and 75.7% were male. The female clients were significantly younger than their male counterparts (p < 0.0001). The women were significantly more likely to report having a sexual partner who was an injecting drug user (OR 9.04, 95% CI, 5.9-13.9) and to be living with an injecting drug user (OR 1.69, 95% CI, 1.2-2.3). They were also significantly more likely to share injecting equipment with their sexual partner (OR = 3.83, 95% CI, 2.7-5.5) and to report recently sharing injecting paraphernalia (OR = 1.79, 95% CI, 1.3-2.5). However, the interval between initiating intravenous drug use and first presenting at the Merchant's Quay health promotion unit was significantly shorter for female clients (p < 0.0001).

Conclusions: One of the most important concerns with regard to illicit intravenous drug use is that of needle sharing, and the associated risks of infection with human immunodeficiency virus and hepatitis. This study highlights the greater personal involvement of women with other drug users, and its consequences in terms of healthrelated problems and risk behaviour. There is a need to address this issue, by taking advantage of the fact that women present for treatment at a younger age than their male counterparts and at a much earlier stage in their injecting career.

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.

Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.

Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.

Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.