Objectives: To examine eating concerns in a cohort of Irish adolescents.

Methods: Students from a stratified random sample of post primary schools were screened using the EAT-26, the EDI-III and a study specific questionnaire.

Results: A total of 3,031 students (mean age 14.74, range 12–19) enrolled in the study. The majority of respondents felt popular (91%), happy (75.2%) and perceived themselves to have a good quality of life (86.8%). Despite this, 32% of females dieted, 29.4% were dissatisfied with their bodies, and 10.8% scored above 20 on the EAT-26. Adolescents always on a diet reported a lower quality of life (QoL) X2(16, N=2,961) =144.43, p <.000, perceived themselves to be less popular X2(15, N=2,963) =53.26, p <.000 and less academically able X2(16, N=2,297) =43.96, p<.000, than those who never dieted. Comparing EPICA values to published norms, Irish males had significantly lower EAT scores, females had comparable total EAT-26 scores but significantly lower levels of dieting and higher levels of bulimic features and oral control. Girls in mixed schools had higher rates of body dissatisfaction F (1,2855) = 16.61, p <.001 and drive for thinness F (1,2860) = 11.78, p <.005 than girls attending same sex schools.

Conclusions: Weight and body image concerns were high among Irish adolescents, especially females, with higher than expected levels of bulimia and oral control scores on the EAT but lower scores on the dieting subscale. Females attending mixed sex schools appear most at risk of eating pathology.

Background: Most children who have Asperger's Syndrome (AS) are not identified until early school age, when social difficulties with other children become evident. Consequently, primary school teachers have an important role to play both in the recognition and management of the condition.

Objectives: Our study sought to examine the perception of primary school teachers regarding the recognition and management of AS.

Methods: A structured questionnaire on the recognition and management of AS was circulated to all 90 primary school principals in the Fingal County of Dublin for them to copy and distribute to teachers in their schools for completion. Self-addressed envelopes were provided to each principal for the return of completed questionnaires.

Results: Three hundred and forty-three completed questionnaires were returned by 54 out of the 90 school principals. Fifty-eight per cent of respondents reported that they had ever taught a child with the condition and 49% reported that recognition and management of emotional and behavioural disorders was covered in their undergraduate training. Some 78.4% said that they would recognise the symptoms of AS in a child, with those who had training on the recognition and management of emotional and behavioural disorders being more likely to report that they would recognise such symptoms while 71.1% said children with AS should be taught in mainstream classes. However, 77.3% did not think mainstream schools are presently adequately resourced to cater for children with AS. Some 96.2% said they would like to receive in-service training from the Child and Adolescent Mental Health Services on the detection and management of children with AS.

Conclusion: There is a need for formal in-service training for all primary school teachers in the recognition and management of children with Pervasive Developmental Disorders (PDD). The recognition and management of children with PDD should also be included in the curriculum of all undergraduate teacher training institutions in Ireland.

Objectives: The Mental Health Act 2001 was implemented in Ireland in 2006, however, within this new legislation there is no provision for compulsory community treatment or advance directives, which are now established practice in other countries. We aimed to determine the proportion of patients who believe that compulsory treatment may be justified, the preference for where the treatment should be delivered and factors which may influence this preference. We also sought to determine the proportion of people who would be interested in the option of having an advance directive in their future care plan.

Methods: Patients who had been admitted involuntarily in a 183 bedded psychiatric hospital in Dublin (St John of God Hospital) over a 15 month period were interviewed one year following discharge. A structured interview was used and included the Birchwood Insight Scale and Drug Attitude Inventory (DAI).

Results: Sixty-seven patients were interviewed, which resulted in a follow-up rate of 68%. A total of 56% of participants believe that there are situations in which involuntary treatment with medication may be justified. Of the participants 59% think that the person should be admitted to hospital if they are going to be administered medication without consent. A total of 41 % of participants stated they would have preferred to have been treated at home rather than hospital and this was associated with having a diagnosis of an affective disorder or it being their first involuntary admission. Of the participants 84% expressed interest in having the option of an advance directive in their treatment care plan.

Conclusions: With the increasing community based provision of mental health services in Ireland a debate on compulsory community treatment orders and advance directives needs to take place amongst all stakeholders.

Objective: To establish time of presentation to paediatric accident and emergency (A&E) services of children with deliberate self-harm (DSH).

Method: All children presenting to an acute paediatric hospital with DSH or suicidal ideation between 1993-2003 were identified and time of presentation collected from their case notes.

Results: Of the 172 children where the actual time of presentation was recorded, the majority of children – 137 (80%) presented to the hospital outside of the ‘normal working hours’ of 9am-5pm, Monday – Friday. These children represent an at-risk group, and were more likely to have consumed alcohol, to have made a suicide attempt, and to have a family history of psychiatric illness than children presenting with “normal working hours”.

Conclusion: DSH in young people is a significant public health problem in Ireland and is a major risk factor for completed suicide. Access to an out of hours on-call Child and Adolescent Psychiatry (CAP) services is essential if these children are to have a mental health assessment, as recommended by the Royal College of Psychiatry and National Institute of Clinical Excellence. These services need to be urgently developed.

Objectives: The aim of this study was to investigate the effects of topiramate (TPM) on cognitive function, specifically language, in patients with epilepsy, and to determine whether a specifically designed neuropsychological test battery can show such effects.

Method: Twenty patients taking TPM, 25 epilepsy controls (taking medication other than TPM) and 25 healthy controls were recruited. We used a specific neuropsychological battery, including measures of visual and verbal memory, attention, fluency and comprehension. Separate one way between group ANOVAs were performed for each neuropsychological measure.

Results: Bonferroni comparisons revealed that the TPM group performed significantly worse than epilepsy controls on digits forward (p<0.001), digits backward (p<0.05), controlled oral word association (COWA) (p<0.05) and token test (p<0.05). The TPM group also needed more multiple choice cues in the Boston naming test (p<0.05).

Conclusions: The present study indicates that 15% of the sample tested had impaired language abilities and raises interesting questions regarding the nature of this effect. Furthermore, we have identified some short neuropsychological tasks that can be performed in routine clinical situations that can reliably identify patients who have negative linguistic effects of TPM.

Objectives: With increasing longevity, more people will develop dementia. These people will have a wide range of needs according to their circumstances. Services in the community struggle to meet these needs. This study aimed to identify needs of dementia sufferers attending the South Dublin Old Age Psychiatry service as rated by their carers, to assess the extent of unmet need and the implication of this.

Method: The carers of 40 community-dwelling people with dementia attending the service were interviewed by one researcher using the Camberwell Assessment of Need for the Elderly (CANE). This measures a wide range of needs over 24 areas, from personal care, to social, financial and psychological care needs. Qualitative information was also obtained from carers regarding services available and their accessibility. A measure of carer stress and satisfaction with help for this was also obtained.

Results: Overall, the highest levels of need identified (both met and unmet) were in the areas of psychological functioning (memory and psychological distress), followed by social needs in the areas of managing money, daytime activities, self-care, and looking after the home. Highest unmet social needs were in the areas of daytime activities, home care and managing money. For 23/24 domains, carers were satisfied rather then unsatisfied with help received. The areas of greatest dissatisfaction to them concerned daytime activities, household skills and self-care. Over half of the carers reported psychological distress.

Conclusion: High levels of need, both met and unmet were identified. Many identified needs related to the provision of community supports in the areas of selfcare, household skills and daytime activities, in addition to psychiatric needs. Assessment of needs is important to ensure adequate and responsive service provision, in keeping with the ethos of community care.

Objective: To examine the frequency of use of seclusion and the factors associated with its use in Lakeview Unit, a 29-bedded acute psychiatric unit in Naas General Hospital.

Methods: A survey was carried out involving a retrospective chart review of all patients secluded over a 12-month period, as well as a review of the seclusion register for this period. Secluded and non-secluded patients were compared for gender, nationality, age, diagnosis, duration of admission and admission status by reviewing discharge summaries of all patients admitted during the 12-month period.

Results: Most (75%) of the secluded patients were secluded only once. Half of seclusion events were initiated in the first week of admission. Length of time spent in seclusion ranged from 50 minutes to 96 hours, with a mean duration of 25 hours 20 minutes. Seclusion was most often associated with risk to others and risk to self. Alternatives to seclusion considered included verbal de-escalation, medication, special nursing, single room accommodation and time out Male and non-Irish patients were more likely to be secluded. There was no significant difference between secluded and non-secluded patients in terms of age. Patients with psychotic disorders tended to be secluded more frequently than others, followed by patients with bipolar affective disorder and substance use disorders. Longer duration of admission and involuntary admission status were strongly associated with seclusion.

Conclusion: Seclusion remains an important part of psychiatric practice on Lakeview Unit, and reflects indirect measures of illness severity. In order to reduce the duration of seclusion episodes, the development of alternative containment strategies needs to be addressed. Seclusion audits should be carried out regularly to ensure that best practice is adhered to.

Objectives: In recent years there have been a number of high profile cases in Irish psychiatry where consultant psychiatrists have been subjected to serious physical assaults. The last survey of assaults on consultant psychiatrists in Ireland was carried out in 1998. Therefore we sought to update the data on this topic.

Method: An anonymous questionnaire was sent out by post to all consultant psychiatrists (n = 330) identified as currently working in the Republic of Ireland.

Results: The response rate was 48.2%. Sixty per cent of respondents were working in general adult psychiatry and respondents were evenly spread throughout the country. Ninety per cent of respondents had been the victim of verbal aggression/intimidation/threatening behaviour while 55% had been physically assaulted. The majority of incidents involved male patients aged between 21-40 years with a diagnosis of paranoid schizophrenia. Nearly 66% of incidents of physical violence occurred during a relapse of illness. The perpetrator had a history of violence in approximately half of all reported incidents. Physical assaults tended to occur more commonly in inpatient settings (63.7%).

Incident reporting occurred more often in physical assaults with 66% reported informally to colleagues and 20% reported to An Garda Siochana (police force of Ireland). Eighty-nine (56%) consultants described feeling ‘safe’ at work. Less than 50% reported the provision of standard safety equipment in the workplace and nearly half ofrespondents had not attended any safety training courses since their appointment. Longer experience working as a consultant psychiatrist did not appear to have an impact on reducing the rate of assaults. In addition, those who attended safety training courses did not report a reduced rate of physical assaults.

Conclusions: These findings highlight the need for both organisational and personal changes in practice in order to reduce the assault rate. Organisational changes include the provision of appropriate safety equipment, safety training for consultants, enhancing multidisciplinary teams and utilising risk assessment. Consultants' personal practices to improve their safety may offer useful information for inclusion in safety training courses. This is an area which merits further research.

Background: Reported rates of depression in schizophrenia vary considerably.

Objective: To measure the prevalence of depression in a first episode sample of people with schizophrenia.

Methods: All referrals with a first episode of schizophrenia diagnosed using SCID interviews were assessed pre-discharge and again six months later. We used the Calgary Depression Scale for Schizophrenia (CDSS) and Positive and Negative Syndrome Scale (PANSS) to assess the severity of symptoms.

Results: Pre-discharge, 10.4% of the sample met CDSS criteria for depression. According to the PANSS depression (PANSS -D) subscale, 3% of patients were depressed, with a mean score of 7.48 (SD = 2.97). Only 3% of patients pre-discharge were found to be depressed on both the CDSS and the PANSS-D. Six months later 6.5% were depressed according to the CDSS. However none reached depression criteria according to the PANSS-D. The CDSS correlated with PANSS-D both pre-discharge and at follow-up. Feelings of depression and self-deprecation were the most common symptoms at baseline and follow-up. The CDSS was unrelated to negative symptoms at both stages. A lifetime history of alcohol abuse increased the risk for depression.

Conclusion: Rates of depression in this sample were low. The CDSS appears to discriminate between depression and negative symptoms. Like the general population, alcohol misuse is a risk factor for depression in first episode schizophrenia.

Objectives: Prescription writing is a basic clinical skill for all doctors; however, errors in prescriptions are frequent and can result in significant harm to patients both from sub-therapeutic dosages and from over prescribing. This study examines the prescribing practices of ‘as required’ medications in an acute psychiatric inpatient unit attached to a university teaching hospital.

Method: A clinical audit was conducted to examine both prescribing practices of ‘as required’ medication and recording of ‘as required’ medication in nursing notes. A series of educational interventions were undertaken in an attempt to improve prescribing practices in relation to ‘as required’ medication and two further audits were completed to assess any change in practice and whether such changes were sustained.

Results: Psycho-education led to an improvement in a number of prescribing practices, including increased generic prescribing, improved documentation of indications for medication administration and increased writing of medication dosages in acceptable abbreviations. These benefits were maintained four months after the education interventions. Rates of documenting the frequency of medication correctly and recording the administration of medication in nursing notes remained low.

Conclusion: Our audit cycle clearly demonstrates that education can ameliorate prescribing practices and these improvements were maintained four months after education was delivered. However some aspects of prescribing practice remained deficient, and more focused educational interventions are required in these areas.

Objectives: Over the counter (OTC) medication abuse is an increasing public health concern. We studied the clinical profiles, treatment and prevalence of patients admitted with OTC opiate abuse.

Method: Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded.

Results: Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.0 mg per person. Some 75% percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have co-morbid psychiatric (n=19, 95%), physical (n=17,85%) and polysubstance (n=13,65%) illness.

Conclusions: OTC opiate abuse is a significant problem which is largely covert in nature with serious co-morbidity and frequent complications including withdrawal symptoms which require treatment. Results of this study suggest that further research is warranted in this area.

Objectives: To assess the degree to which a sample of older individuals – who are engaged with psychiatric services – are knowledgeable about their medication and the reason for its prescription; to assess the degree to which these patients adhere to what is prescribed.

Methods: Convenience sample of 24 patients over 65 years old, under the care of psychiatric services for Later Life, included. Patients who scored < 23 on Mini-mental State Examination were excluded. A questionnaire was administered which evaluated patients' knowledge of the names of, and reasons for, all prescription medications. Adherence rates were measured. Comparisons were made regarding to self-reported adherence rates and medication knowledge. These were based on diagnosis, age, number of medications prescribed and the presence or absence of sensory impairment.

Results: The median percentage of medication names recalled was 60%. A total of 25% of patients reported having some problem with adherence. No patient with a diagnosis of dementia was able to recall the names of, or reasons for, all medications prescribed. Patients with depression and dementia were as likely to be fully adherent as the total sample. Patients (a) aged 78 years or more and (b) those who were on more than six medications – were less knowledgeable about and less likely to adhere to prescribed drug regimens. We did not identify an association between reduced visual acuity and reduced medication adherence

Conclusion: Patients require ongoing education concerning all aspects of medication, especially the reasons for prescription. Older patients and those receiving more complex regimens may be at particular risk of adherence problems.