Gambling legislation in Ireland has not been amended for the last several decades. The proposed Gambling Control Bill 2013 provides the opportunity to enact a bill in accordance with the current trends in gambling. The classification of Gambling Disorder in DSM 5 under Substance Use Disorders in 2013 highlights the addiction potential of gambling and the perils associated with the same. This editorial discusses the prevalence of gambling disorders, its societal implications, mental health conditions co-morbid with gambling disorders, screening tools available for gambling disorders, and the treatment options available for gambling disorders at present. Furthermore, factors to be considered before enacting the proposed Gambling Control Bill 2013 into legislation have also been discussed.

This study assessed both executive function (EF) and prospective memory (PM) in a group of current smokers (CS) to observe whether deficits in both sets of memory processes co-existed in smokers, comparing this group with a group who had never smoked (NS).

An existing-groups design was used to compare smokers with the NS group on a Reserve Digit Span Task (RDST) that measured EF and the Cambridge Prospective Memory Test (CAMPROMPT) measuring PM. Age, mood, other drug use and IQ were also measured and controlled for in the study.

After omitting anyone using an illegal substance and observing no between-group differences in age, gender, anxiety, depression, alcohol use and IQ, the CS group performed significantly worse on the RDST and recalled significantly fewer time-based and event-based tasks on CAMPROMPT, compared with the NS group.

Both EF and PM deficits were evident in the same cohort of CS when compared with a NS group, a finding which is novel in the current literature. Since both EF and PM are interrelated in that they share common resources in the brain, the finding that both sets of deficits co-existed in smokers suggests that persistent cigarette smoking impedes these underlying resources.

This study describes the attitudes, knowledge and prescribing of psychotropic medication in children.

A study-specific questionnaire was mailed to all child psychiatrists, paediatricians and a group of registered general practitioners (GPs) from a selected Child and Adolescent Mental Health Services catchment area.

In the 116 respondents who replied (39% response rate), psychotropic medication was generally valued and used by all groups (70.1%). Respondents believed that the majority (61.9%) of their non-medical colleagues would also value/support the use of medication and this endorsement influenced the respondents’ prescribing rates. Initiating medication was viewed as the province of child psychiatry (78.6%). Medication is felt to be justified in a wide variety of mental health disorders, their use being reserved for severe presentations, with psychostimulants and selective serotonin reuptake inhibitors being most used. A significant number of GPs (60.9%) and paediatricians (63.4%) were felt to be lacking in competence in psychotropic prescribing, with a general request for more seminars in this area (61.5%) with almost half (45%) of them believing that they would prescribe more often.

The use of psychotropic medication in children remains a valued and common practice in Ireland. Attitudinal and practice differences across professional groups exist, and although the experience is one of relative safety there was a strong desire for further education leading to a perceived increase in utilisation. The impact of perceived public opinion regarding psychotropic prescribing along with a lack of competence may represent a major barrier to effective prescribing, thus highlighting the importance of ongoing professional development and increased public health initiatives to increase knowledge and understanding in this increasingly important area.

The Mental Health Act 2001 was implemented in 2006 to bring Ireland into line with international practice and United Nations Conventions on Human Rights. Previous studies have reported some practical difficulties for the professionals involved. We wished to examine the experiences of nursing staff and the impact of the Act on clinical nursing practice since its implementation.

This cross-sectional survey was conducted by questionnaire. It contained questions examining training in and attitudes to the Act, and any resultant changes in nursing practise.

A total of 317 questionnaires were returned. Of the nurses, 92% reported having received training in the Act, and 56% of nursing staff believed that their workload had increased as a result of the change in legislation. Of those who made a comment, 76.5% were negative, with increased paper work, lack of clarity and an excessive focus on legalities being the most common difficulties reported.

Nursing staff have shown mixed attitudes to the Mental Health Act 2001, but many of the difficulties encountered are similar to those experienced by other professionals.

To examine the impact of a change in local prescribing policy on the adherence to evidence-based prescribing guidelines for antipsychotic medication in a general adult psychiatric hospital.

All adult in-patients had their clinical record and medication sheet reviewed. Antipsychotic prescribed, dose prescribed and documented indications for prescribing were recorded. This was done before and after the implementation of the change in hospital antipsychotic prescribing policy.

There were no significant differences in age, sex, Mental Health Act status, psychiatric diagnosis or documented indications for prescribing multiple or high dose antipsychotics between the two groups. There was an increase in the preferential prescribing of multiple second-generation antipsychotics (p=0.01) in the context of a significant reduction in the prescribing of multiple antipsychotics overall (p=0.02). There were no significant reductions in prescribing of mixed generations of antipsychotics (p=0.12), high dose antipsychotics (p=1.00) or as required (PRN) antipsychotics (p=0.74).

Changes in local prescribing policy can improve adherence to quality prescribing guidelines and cause clinically significant improvements in patterns of prescribing in a general adult psychiatric hospital.

Newspaper media are an important source of information regarding mental health and have a significant influence on people’s awareness of, and decision making around, mental health issues. Depression in young people has seen increasing media attention in recent years, but few studies have examined media representation of mental health, specifically in young people. The current study used a quantitative approach to examine the words used in reports concerning depression in young people, in Irish broadsheets, published between 2007 and 2011.

A sample of 269 texts, containing 176 223 words, was collected from three Irish broadsheet newspapers, using the search terms ‘depression’ or ‘depressed’ or ‘mental health’ and ‘youth’ or ‘young people’. A corpus-based approach was used to examine word frequencies, clusters and keywords.

The analysis identified textual patterns, suggesting recurring associations between youth depression and suicide, and, to a lesser extent, alcohol use and bullying. Keywords relating to emotional distress and symptoms of depression were less frequent and sometimes associated with constructions inferring lack of agency (such as ‘suffering from’). A focus on the role of the parents was also evident. Of the professions mentioned, psychiatrists were referred to most often.

The analysis suggests that media coverage of depression in young people accurately reflects concerns reported in surveys by young people, but provides less information that might help in recognising depression in a young person.

Service user involvement is receiving increasing support from mental health policy makers, service planners and research commissioners. However, we lack a good understanding of the nature and extent to which service users are involved in personality disorder (PD) services and the effects of involvement in these services.

To review and appraise published sources; increase understanding about service user involvement in PD services; and highlight knowledge gaps and related issues.

A scoping review methodology was adopted. Data were ‘charted’ to illustrate the landscape of writings and views and a qualitative analysis synthesized the results in terms of key emergent themes.

Only a small amount of published work was identified with significant gaps in the literature. Effects were reported mostly in terms processes and emotional and practical benefits for service users. Emergent themes were wellness and health, recruitment and support for service users.

This scoping review uncovered a lack of published work despite service user involvement being a key strand of health policy. There is a need for outcomes-focused research regarding service user involvement. Successful user involvement in PD services requires attention to be focused on the context, recruitment, support and ‘wellness’ of service users.

The main objectives were to assess medical students’ opinions about e-learning in psychiatry undergraduate medical education, and to investigate a possible relationship between learning styles and preferences for learning modalities.

During the academic year 2009/2010, all 231 senior Royal College of Surgeons in Ireland (RCSI) medical students in their penultimate year of study were invited to answer a questionnaire that was posted online on Moodle, the RCSI virtual learning environment.

In all, 186 students responded to the questionnaire, a response rate of 80%. Significantly more students stated a preference for live psychiatry tutorials over e-learning lectures. Students considered flexible learning, having the option of viewing material again and the ability to learn at one’s own pace with e-learning lectures, to be more valuable than having faster and easier information retrieval.

Students prefer traditional in-class studying, even when they are offered a rich e-learning environment. Understanding students’ learning styles has been identified as an important element for e-learning development, delivery and instruction, which can lead to improved student performance.

To identify whether clinical information routinely collected and recorded on clinical files is available for the identification of metabolic syndrome and to assess the prevalence of risk factors for the syndrome in a sample of people with intellectual disabilities (ID) and mental illness treated with antipsychotic medication.

A retrospective analysis was performed for 76 adults with ID and comorbid mental illness, for whom treatment with antipsychotic medication was established. Statistical analysis was performed using SPSS 16.0. The Student t-test for parametric data and χ2-test for non-parametrical data were used.

Five of the six criteria for metabolic syndrome were available in all or a high proportion of the files, however no measurement for waist circumference was recorded in any of the files. Aripiprazole appears to be the least risky antipsychotic for metabolic syndrome.

It is important to develop a systematic protocol to record diagnostic variables for metabolic syndrome in at risk populations such as those with ID and mental illness treated with regular antipsychotics.

The emergence of mental health services for older people is a relatively recent development in Ireland. Therefore, it is important to determine strengths and limitations of this modern-day care service. A starting point is to enquire from those who have been in receipt of their service and/or their respective carers.

This study aims to identify and describe the perceptions and experiences of past service users (SUs) and their carers, while in receipt of services from an acute mental health day hospital for Psychiatry of Later Life and to explore their needs/supports.

A qualitative, exploratory, descriptive design was employed. Purposive sampling achieved a sample of 13 SUs and six carers. Inclusion criteria set were that the SU had a diagnosis of a psychiatric disorder; had the capacity to make an informed consent and communicate verbally and the SU was discharged from the service between January and July 2011. Finally, carers of SUs in receipt of the service during this time were also included. Data were subjected to thematic, field analysis.

‘Person centredness’ emerged as an overarching theme. Six inter-related subthemes revealing how SUs and carers viewed their care emerged from the interviews: ‘therapeutic engagement’; ‘preservation of self-integrity’; ‘collaborative care’; ‘integrated care’; ‘social gains’; and ‘the relationship between the expectation, subsequent engagement and the perceived outcome of care’.

Findings concluded that high levels of care exist within this service. Strengths lie in the development of a therapeutic relationship, preservation of self-integrity, social gains and robust elements of person-centred holistic, integrated and collaborative care

Recommendations support the enhancement of a cohesive planned approach to admission, discharge/transition (integrated pathway).

Alcohol consumption during pregnancy potentially has significant effects on both mother and baby. The aim of the study was to determine the effectiveness of a brief intervention to reduce alcohol consumption during pregnancy.

This study was performed at the outpatient antenatal clinics of a large academic maternity teaching hospital in Dublin city centre. Six hundred and fifty-six women who drank alcohol before pregnancy were recruited at their first antenatal clinic visit. Drinking patterns before pregnancy, since becoming pregnant, and in later pregnancy (at ~32 weeks of gestation) were assessed using the Alcohol Use Disorders Identification Test (AUDIT). A controlled study was conducted – participants were allocated to either the brief intervention group (screening and 5 minutes of non-directive discussion of their drinking pattern) or a control group (screening and treatment as usual).

Before pregnancy, 57% of women consumed five or more units of alcohol per drinking occasion (i.e. binge drinking); during pregnancy, the rate of binge drinking fell to 4.8%. Sixty per cent of women who drank before pregnancy ceased drinking when pregnant, and a further 9% reduced their intake substantially. Four hundred and ninety-nine women were followed up in later pregnancy. The brief intervention did not produce any significant reduction in alcohol consumption above that attributable to pregnancy and comprehensive screening in antenatal care. Larger reductions in alcohol intake during pregnancy were associated with younger age, non-Irish nationality and greater intake of alcohol before first antenatal clinic visit.

Pregnancy itself produces abstinence and large reductions in alcohol consumption, even among women who drink relatively heavily. Consequently, a universal screening and brief intervention programme is not warranted but screening and targeted interventions could be appropriate such as repeated interventions for those who continue to binge drink. Future research could include evaluating interventions for those women who continue to binge drink during pregnancy and exploring ways of maintaining reductions in alcohol consumption among women who decreased consumption during pregnancy.

To examine attitudes and practices in the management of attention-deficit/hyperactivity disorder (ADHD) among health professionals across seven European countries.

The web-based survey was developed by an international steering committee of ADHD experts and consisted of 64 multiple-choice questions relating to ADHD, covering the following topics: attitudes, diagnosis, referral, treatment and improving care. Health professionals working with ADHD were identified using a medical marketing database (Medical Marketing Service Inc., IL, USA) and invited via email to participate in the survey. No incentive was offered for participation and the survey was only available in English.

Over 22 000 emails and postal invitations were sent. One hundred and thirty-four (0.6%) health professionals completed the survey. Results highlighted significant differences by profession and country. In general, ADHD is considered a clinically important and valid disorder (n = 111, 84%), with biological underpinnings (n = 82, 62%), continuing into adulthood (n = 123, 93%) and responsive to treatment. Respondents from France were less likely to be convinced about biological validity (n = 4, 27%) and those from Italy and France were more likely to be concerned about the risk of underdiagnosis (n = 9, 64% and n = 9, 60%, respectively). Psychologists were the specialty who most frequently reported not believing in the diagnostic validity of ADHD (n = 4, 19%). One-third (n = 25, 35%) of respondents recommended medical tests before prescribing medication, with differences emerging by country despite the lack of support for such routine assessments in the guidelines.

Despite the very low response rate, intriguing country- and profession-specific differences emerged in this study and warrant further exploration.

This study was to assess the attitudes and practice of, senior psychiatric trainees with regard to bibliotherapy.

A brief online survey was used to assess the attitudes to and practice of bibliotherapy among senior psychiatric trainees in Ireland. There were 34 responses out of 82 (response rate 41.5%). Respondents were asked to indicate their agreement with three statements.

The majority 27 (79.4%) strongly agreed or agreed that they were comfortable recommending books, with none strongly disagreeing and 4 (11.8%) disagreeing. Over half 20 (58.8%) of respondents strongly disagreed or disagreed that self help books could only be a poor substitute for psychotherapy or counselling, with none strongly agreeing and 2 (5.9%) agreeing. Many 19 (55.9%) disagreed or strongly disagreed that self help books could do more harm than good, with 8 (23.5%) agreeing or strongly agreeing. Finally respondents were asked to state their awareness of prescribe-a-book schemes. 4 (11.8%) respondents reported awareness, with 30 (88.2%) unaware of any such schemes.

Although majority of senior psychiatric trainees were comfortable recommending self help books and did not consider them harmful, most were unaware of such schemes in Ireland.

The purpose of this paper is to trace the origins and decline of the diagnostic entity monomania, which became prevalent in the early 19th century and to investigate its use in Irish psychiatry.

The French psychiatric scientific writings of the early 19th century have been surveyed to identify and describe the clinical entity of monomania. The clinical description of monomania has been investigated and its cultural diffusion through literature and the arts has been reviewed. The increase in its use as a diagnosis and its ultimate decline has been documented in France, Britain and Ireland. The clinical characteristics leading to the diagnosis in Ireland have been investigated through the clinical symptoms recorded in patients accorded this diagnosis in the 19th century case books and committal documentation of the Richmond District Asylum and case books of the Central Mental Hospital.

The diagnostic entity of monomania first emerged in France in the 1820s and had disappeared from use in the hospitals of Paris by 1870. It first appeared in Ireland in the patients’ admission register of the Richmond District Asylum in 1833 and increased substantially before decreasing just as markedly with the last patient, given the diagnosis on admission being in 1878. However, the diagnosis of monomania was applied to admissions to the Central Mental Hospital as late as 1891. The Irish asylum case books have been of limited value in elucidating the clinical and symptomatological presentations leading to its use by 19th century Irish psychiatrists.

Monomania, although enjoying a scientific and cultural success in France, both within and without psychiatric circles, was a tenuous clinical entity with an ill-defined and uncertain core and fragile boundaries, both in France and more particularly in Ireland. In pure form, rarely described, its closest modern equivalent would have been delusional disorder, but case descriptions only occasionally correspond to this concept as it is understood today. Its popularity dating from around 1830 declined and by the 1870s it was in terminal decline. The factors delineating its rise and fall are unclear.

Co-prescription of linezolid and serotonergic agents (SSRIs, SNRIs, NaSSA, TCAs) can lead to serotonin syndrome, this study seeks to identify prescribing practise of these agents.

Study of all general hospital inpatients prescribed intravenous linezolid in a 3-month period, using drug charts and clinical notes.

Co-prescription occurred in 20% with SSRIs most frequently concurrently used. There were no cases of serotonin syndrome. There was no evidence in clinical notes of vigilance for potential interaction.

Co-prescription is common; awareness of potentially serious interaction is not evident in current practice.