Anorexia Nervosa (AN) has the highest rates of morbidity and mortality of any psychiatric disorder. Psychiatrists in Ireland have reported difficulties in managing patients with AN, particularly those with severe levels of illness. This paper explores these management difficulties, including the financial and organisational impediments to service provision, and the legal and ethical dilemmas involved in dealing with those patients who refuse treatment.

This study sets out to make a meaningful and useful contribution to the discussion surrounding the treatment of heroin addiction in Ireland. The study took place in nine urban general practices in Dublin city. Twenty five service users were interviewed in-depth. A phenomenological approach drawing on the psychological research methods of Colazzi for data analysis informed this study. Four themes emerged from the data: Service users' the significance of methadone for the service user; service users' understanding of the Methadone Treatment Protocol and the experience of addiction and its effect on families.

This paper reports on the experiences of service users receiving methadone treatment in urban general practice in Dublin and in so doing highlights the influence of the GP in supporting recovery. It explores the theme - Service User's Experience of attending general practice for methadone treatment. These accounts provide insight into the harm reduction policy of methadone maintenance and highlight how - from the service users' experience - the implementation is falling short.

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.

Background: Evidence from regions where there have been severe dietary restriction suggests that individuals in utero during periods of starvation may subsequently be at increased risk of schizophrenia. Because Ireland was the location of a major nineteenth century famine an attempt has been made to determine whether any such evidence for famine/schizophrenia association can be found.

Method: The data used derive mainly from the Annual Reports on the District, Criminal and Private Lunatic Asylums supplied by the Inspectors of Lunacy in Ireland for the relevant years. Nineteenth century diagnostic labels have been adjusted to conform to schizophrenia as currently understood. Evidence relating to a possible schizophrenia increase in famine-related emigrants is examined.

Results: There was an increase in first admission rates for schizophrenia of 85.7% from 1860 to 1875. Admissions for other disorders, chiefly melancholia, also increased. Similar admission increases were evident in other jurisdictions over the same period. Data relating to the mental health of famine – migrating Irish are sparse and of difficult interpretation.

Conclusion: The evidence from available data sources attempting to link the Irish famines of the 1840s with a subsequent increase in the incidence of schizophrenia is equivocal and inconclusive.

Objective: Recovery has become an increasingly significant concept within mental health literature. Despite this, few studies have investigated the measurement of recovery and its correlates using quantitative methods. The aim of the current study was to measure recovery in people with chronic psychiatric disabilities using a quantitative tool and to investigate what factors were correlated to recovery outcomes. It was hypothesised that measures that investigated the individual's subjective sense of well-being would have a stronger correlation to recovery than more traditional clinician-rated scales.

Method: Participants were 63 people with a chronic psychiatric disability. They were recruited as a convenience sample from community mental health rehabilitation teams in three locations. Using a cross-sectional design, participants completed measures of psychological well-being (Psychological Well-being Scale (PWB); hope (Adult State Hope Scale) and recovery (Recovery Assessment Scale (RAS). Health professionals rated participants' psychosocial functioning using the Multnomah Community Ability Scale (MCAS-R).

Results: Analyses found that there was no significant correlation between clinician-rated psychosocial functioning scores and participant-rated recovery outcomes. Psychological well-being variables rated by the participants themselves were found to significantly correlate with recovery outcomes. The variables hope, environmental mastery and relationships with others were found to emerge as independent predictors of recovery scores.

Conclusions: Results underscore the premise that recovery is a distinct construct that is unique to the individual and cannot be fully captured by objective measures of functioning. Implications for practice suggest that services for people with chronic psychiatric disability should utilise recovery focused tools in patient assessment and treatment in order for a comprehensive assessment to be achieved. Recovery interventions should also focus on the individual's hope, mastery and relationships with others in order to promote recovery.

Aims: To identify the sociodemographic, clinical and service delivery risk factors for suicide in psychiatric patients in a limited geographic area.

Method: A retrospective case study of 35 patients who died as a result of suicide between January 2006 and December 2008.

Results: Male gender, unemployment, living alone, basic education and significant life events were identified as sociodemographic factors. A history of previous psychiatric admission, previous suicide attempt, suffering from depression, co-morbidity of another psychiatric disorder (mainly stress-related symptoms and alcoholism), and contacting the services prior to suicide were found as typical clinical factors. Hanging was the most common method of suicide in both men and women. Most men died in spring and summer, while the majority of females died in autumn.

Clinical implications: As in similar studies, mental disorders could be identified as the strongest risk factor for suicide. Almost 70% of suicides were conducted by people suffering from a mental disorder. Treating mental disorders and identifying certain sociodemographic and clinical characteristics of people suffering from mental disorders and addressing them is the key in suicide prevention strategies.

Objectives: To describe the characteristics of patients who present to an approved centre with Mental Health Act 2001 forms, and secondly, to compare those who were subsequently detained to those who were not detained.

Methods: Specific data on patients who presented to South Lee Mental Health Unit with application and recommendation forms for Involuntary Admission over a 22 month period was gathered from a retrospective case note review. Information on both groups was compared statistically using Graph Pad Prism software.

Results: 71% (n=121) of patients presenting for involuntary admission did so outside of normal working hours. Those who were not subsequently detained were more likely to have had their application made by the Gardai and their recommendation made by someone other than their own General Practitioner (GP). GPs were more likely than Consultant Psychiatrists to cite risk to self or others as the reason for involuntary admission.

Conclusion: Although involuntary admissions most often occur in emergency situations, every effort should be made to ensure that those who are known to the patient are involved in the process of application and recommendation. In addition, there is a need for ongoing training and education of those most commonly involved, such as the Gardai and General Practitioners, as well as feedback to these groups when a patient presents who does not require involuntary admission.

Objective: High rates of alcohol-related harm have been reported in the European Union, including Ireland, for more than 20 years. This article's goal is to contextualise such rates by examining gender-based pathways to alcohol use disorders from the perspective of those self-identifying as in recovery using data collected midway through this 20-year trend.

Methods: Sixteen informants (nine men and seven women) were interviewed between 1998 and 1999 in Dublin, Ireland. Using qualitative methods, informants were asked to reflect upon their experiences of problem drinking and recovery.

Results: Drinking expectancies, pub-based socialising, social anxiety and perceived social expectations to drink were cited as common pathways to problem drinking by informants, highlighting contradictions in drinking practices and the symbolic functions of alcohol. Drinking contexts identified by informants were public pub-based drinking for men and home-based drinking for women. Primary barriers to problem acceptance centered on pub-based socialising norms and gender-based shame. Benefits of support group membership included establishing new social networks and learning alternative ways to cope with negative emotions.

Conclusion: Consideration of drinking expectancies, the social contexts in which problematic drinking occurs, gender ideologies, the cultural meanings of drinking behaviours, and attention to feelings of isolation or loneliness experienced by those exhibiting problematic consumption behaviours might further understandings of potentially harmful drinking, especially in periods of economic uncertainty.

Aim: To evaluate patients' satisfaction with a psychiatric day hospital in the West Galway Catchments area.

Study design: This is a cross-sectional study. Methods: This study was undertaken by using a 33-items questionnaire for 44 patients who attended the day hospital. SPSS version-12 was used for collecting and applying tests to the data, Fisher's exact test was used to analyse the data as sample size is small and P<0.05 was considered statistically significant. Results are also presented in the form of descriptive analysis including percentages and frequencies.

Results: Only 37 out of the 44 patients returned the questionnaires. Among the participants were 61% (n=22) male and 38% (n=15) female. The patients were mostly satisfied with the services available at the day hospital, except the waiting period for a first appointment. There was no significant (P=0.11) gender difference in terms of patients' satisfaction with the day hospital service. The age group, 45 years and above, were less satisfied (P=0.02) with the availability of a comfortable room for counselling, as compared to the younger age group. The patients did not like to tell others that they were attending the day hospital. The results were comparable with previous published patient satisfaction surveys using the same questionnaire by the Health Research Board, except that the patients in the present survey were more satisfied with the waiting area and availability of counselling.

Conclusions: Patients are mostly satisfied with the West Galway day hospital services.

The older patients (45 years and above) are not satisfied with the counselling room, and therefore further investigations are needed to ascertain their requirements for a counselling room. Patients are more satisfied with the waiting area and availability of counselling compared to the findings of other similar studies conducted in Ireland. Resources are needed to be allocated to the day hospital services.

Objective: To determine the prevalence of mental illness among the residents of a homeless hostel in inner city Dublin.

Method: A cross-sectional survey was carried out among hostel residents, as previous studies have indicated that homeless hostel-dwelling men in Dublin constitute the largest single grouping of homeless Irish people. All agreeable residents were interviewed by the authors over an eight-week period using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Clinical Version. For each disorder, the current (30-day) and past prevalence was determined.

Results: A total of 38 residents were interviewed, resulting in a response rate of 39.2% for the study. A total of 81.6% of residents had a current Axis I diagnosis; this number increased to 89.5% when combining current and past diagnoses. Only four residents had no diagnosis. There was considerable comorbidity between disorders, with a significant number of residents experiencing both mental illness and substance use problems. When considering lifetime diagnoses, 31.6% had a single diagnosis only; 57.9% had two/more diagnoses. Twelve residents (31.6%) had been admitted to a psychiatric hospital during their lifetime. The most prevalent disorders during the past month were Alcohol Dependence (23.7%), Opioid Dependence and Major Depressive Disorder (both 18.4%), Opioid Abuse and Alcohol-Induced Depression (both 7.9%). Only 23.7% of interviewed residents were attending psychiatric or addiction services. A significant number of residents who did not wish to participate in the study were identified by hostel staff as having a confirmed psychiatric diagnosis.

Conclusion: The survey demonstrated a very high prevalence of mental disorders among homeless hostel residents. The high prevalence of dual diagnosis highlights the need for greater collaboration between psychiatric services and addiction services. The outcome also points to the importance of providing mental health training to emergency shelter/hostel staff. Research into the mental health status of the homeless should be undertaken regularly if services are to be planned to meet the needs of this vulnerable group.

We report on the case of a middle-aged woman with a complex psychiatric history in whom atypical intrusive imagery identified in the mental status examination appeared to represent an emergence of childhood dissociative phenomena. These new symptoms led to the reappraisal of her clinical presentation and a diagnostic re-evaluation that they represented a re-emergence of childhood post-traumatic stress disorder secondary to sexual abuse. We discuss the phenomenology identified in our patient with the aim of increasing awareness of unusual symptoms in adults with a history of childhood sexual abuse and the importance of the mental state examination in eliciting and classifying such phenomena.

Objectives: The aim of this study was to determine the views of both individuals attending the mental health services (attendees) and mental health professionals in relation to how attendees and staff should be addressed, how attendees should be described, and how staff should be attired.

Methods: We surveyed 132 attendees of the West Galway Mental Health Services and 97 mental health professionals in relation to how they prefer to be addressed (first name/ title and surname/ no preference) the description of attendees (patient / client / service user / no preference) and the attire of mental health staff (casual / smart / no preference). We also ascertained how mental health professionals believed attendees would view these issues.

Results: Attendees preferred to be described as patients rather than clients or service users by all mental health professionals, with 46-54% of attendees preferring this term “patient” compared to 14-17% preferring the term “client”, 11-13% preferring the term “service user” and 20-25% having no preference (p < 0.001). They preferred to address doctors by their title and surname (61%) but other mental health professionals by their first names (60-69%) (p < 0.001). Attendees had a strong preference for being addressed by their first names by all the mental health professionals (86-91%) (p < 0.001). Doctors preferred to be attired formally (88%), compared to nurses (50%) or other mental health professionals (42%) (p = 0.002). Attendees had no preference in relation to the attire of doctors but preferred other mental health professionals to be attired informally.

Conclusions: The study demonstrates that despite the increased use of several non-medical terms to describe attendees of mental health services; the preferred term of attendees of the psychiatric services in both in-patient and out-patient settings remains ‘patient’. However, this is not universally the case, and the ascertainment of the preference of the attendee at the first encounter with the health professional should be ascertained. We also demonstrated that attendees preferences in relation to both “dress and address” of doctors is significantly different to their preference for nurses or other allied mental health professionals; which may reflect a wish for a less familiar and more formal interaction with doctors.

Objective: This study was conducted to gauge the attitude of fifth year medical students to psychiatry as a potential career choice and to determine if an eight-week clinical attachment had any impact on this.

Methods: We surveyed a cohort of fifth year medical students from Trinity College Dublin. A purpose designed, self-completed questionnaire was used to establish a number of variables and was given to students on the first and last day of their attachment in psychiatry. Participation was optional and responses were confidential. Questionnaires were distributed following an explanation of the purpose of the study.

Results: The survey was applied to 118 fifth year medical students. The most significant finding of the study was the increase in number of students choosing psychiatry (17%) as a possible career upon completion of the attachment as compared to before (4%). The majority of the students considered psychiatry as a mainstream specialty with little change in this perception pre and post attachment. Almost all of the students believed that a psychiatry posting would improve their communication skills when dealing with patients.

Approximately half of students chose medical subspecialties as career choice prior to their psychiatry posting but this declined afterwards. There was a small increase in the number of students wanting to become GPs and those who were undecided about their potential career choice.

With regards to deterrents to doing psychiatry, the principal one was the belief that psychiatry was too depressing and stressful. Lack of interest, adverse career prospects and financial considerations featured in a minority of student answers.

Conclusions: The findings of this study suggest that psychiatry remains less attractive to students as a career compared to some other specialities but a clinical attachment may be an important means of raising interest in psychiatry as a career.

Objective: Alcoholism ultimately leads to impairment of memory and other cognitive functions. This can interfere with treatment, if cognitively impaired alcohol-dependent individuals have difficulties recalling and implementing skills acquired during therapy. We investigate if alcohol-dependent individuals without clinically apparent withdrawal symptoms may still be impaired in higher-order cognitive functions.

Methods: Thirty-four alcohol-dependent patients and 20 matched healthy controls were tested with the Verbal Learning and Memory Test which includes seven measurement points. The test comprises free recall, free recall after distraction and after 30 minute delay, and a word recognition task. Testing was performed between day seven and day 10 after the beginning of abstinence, when clinical withdrawal symptoms had ceased.

Results: Compared to healthy controls, alcohol-dependent patients performed worse in free recall after delay, but not in word recognition. Healthy controls showed a more linear progression of improvement in verbal memory performance. Overall, alcohol-dependent individuals showed reduced verbal learning efficiency. The extent of impaired recall after distraction was positively associated (one-tailed test) with history of delirium (r=0.34, p=0.04), seizures (r=0.46, p=0.01), and years since diagnosis for alcohol dependency (r=0.39, p=0.01).

Conclusions: Our results provide evidence that unmedicated alcohol-dependent patients without obvious withdrawal symptoms had impaired verbal recall, but normal recognition performance, at seven to 10 days after onset of abstinence. This deficit may deteriorate treatment outcomes due to poorer implementation of skills newly-learned during this time period.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.

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.

Objective: This study explores unrecognised symptoms related to post-traumatic stress disorder (PTSD) in individuals with a range of psychiatric disorders in the absence of traumatic events. We also examine the association between PTSD symptoms, social interaction with peers and therapeutic alliance with mental health professionals.

Method: A purposive sample of 120 adults consecutively referred to the psychology department from September 2008 to September 2010 was included in this study. We used the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) to ascertain the presence of PTSD symptoms, social interaction levels and treatment alliance with health professionals.

Results: Individuals previously undiagnosed with PTSD, referred without any noted traumatic event had high levels of symptoms related to PTSD, as measured by the PK scale of the MMPI-2. The PK scale was significantly correlated with several MMPI-2 clinical scales, the Social Introversion Scale (Si) and the Treatment Alliance Scale (TRT) (p < 0.001).

Conclusion: This study demonstrated the presence of symptoms related to PTSD in individuals with a range of psychiatric disorders despite the absence of reported trauma. The presence of symptoms related to PTSD may be associated with an indirect negative impact on social contacts and a poorer therapeutic alliance with mental health professionals. Investigating symptoms of PTSD during a psychological assessment even when trauma is not the presenting complaint is merited in most cases.

Objectives: Initial examination of data held by the Mental Health Commission indicated a number of patients having repeated involuntary readmissions (defined as patients having three or more involuntary episodes in a calendar year). The Commission sought more empirical analysis of the data relating to these patients, to determine if there were any trends or commonality regarding their demographic characteristics, length of episode, and diagnoses.

Methods: From 1 November 2006 the Mental Health Commission has been notified of all involuntary admissions in Ireland under the Mental Health Act (2001). From this national database information on patients who have had three or more involuntary admissions per year was analysed.

Results: In the period studied there has been an overall reduction in the number of voluntary and involuntary admissions to Irish psychiatric hospitals and units. However, the use of involuntary admission remains constant at around 10% of all admissions. Seven percent (n=569) of involuntary admission orders in this four year period relate to two percent (n=121) of all involuntary patients. Patients who have experienced repeated involuntary admissions are predominantly male (59%), often have a diagnosis of schizophrenia, or schizotypal and delusional disorders (57%), or mania (20%), are in the age band 22-64 (80%) and more often live in rural counties.

Conclusions: Potential appears to exist to significantly reduce the number of involuntary admissions by focusing on the care given to patients who are repeatedly re-admitted. More analysis is needed of voluntary and involuntary re-admissions if inpatient facilities are to be effectively configured.