Objective: The aim of this study was to determine the prevalence of metabolic syndrome and obesity as defined by Body Mass Index (BMI) in a long-stay psychiatric unit where all care is provided by the psychiatric team.

Method: All residents in this long-stay unit were screened. Their BMI was calculated. Waist circumference and blood investigations were done. Ward records were used to determine those who had been previously diagnosed with hypertension and diabetes. The ATP 111 criteria were used to determine the prevalence of metabolic syndrome.

Results: We found a prevalence of 33% for BMI obesity and a prevalence of 66% for metabolic syndrome. These are higher than those of the general Irish middle aged population and the accepted estimate of a general psychiatric population. It is also higher than that of a previous published study on an Irish long-stay psychiatric ward population.

Conclusion: There is high prevalence of BMI obesity and metabolic syndrome in long-stay psychiatric residents. This has the potential to impact significantly on physical morbidity and mortality. People with severe and enduring mental illness should have access to primary care and other health services on the same basis as any other citizen.

In order to assess the value of a group program for long-stay elderly patients in an acute care hospital, eight patient outcomes were compared over a six month period within the group and on the nursing units. The activity program was designed to help patients maintain or improve their functional levels while waiting for placement. All patients improved or maintained their functional levels in the group, but these outcomes were not consistently transferred to the nursing units. More intensive geriatric rehabilitation and attention to the unit milieu appear to be needed to maintain gains and to improve functional abilities of long-stay elderly patients in the acute hospital setting.

Objective: All patients who resided in state provided long-stay care in Ireland were required to pay the state for that care until 2006. In 2001 the Irish Ombudsman and Information Commissioner had highlighted the issue of the entitlement of people with medical cards to provision of free long-stay care. The Health Repayment scheme was subsequently set up in 2006 to facilitate the repayment of long-stay charges wrongly paid by patients. Issues of mental capacity arise particularly in the context of long-stay psychiatric patients applying for repayment of long-stay charges. Our aim was to devise a test suitable to assess the capacity of an individual to make an application for refund charges.

Method: There was no specific test in existence to assess the capacity of an individual to make an application for refund of charges. A suitable test was devised based on the available literature which assessed whether the person understands the ‘nature and effects’ of making a refund application. Fifty-eight long-stay patients were deemed to be entitled to apply for a refund.

Results: Staff identified 47 (80%) patients as possibly lacking the capacity to make an application. Of these, 14 patients (29.8%) were found to have capacity to make an application (mean age 58.5 years) with 33 (70.2%) found to lack capacity (mean age 73 years). Of those with capacity 50% had a diagnosis of schizophrenia/schizoaffective disorder. None had cognitive impairment of degenerative origin. Of those who lacked capacity 45.5% had a diagnosis of dementia. All of the patients with dementia who were assessed were found to lack capacity whereas 59% of those with a diagnosis of schizophrenia/schizoaffective disorder lacked capacity.

Conclusion: A substantial number of long-stay psychiatric patients may lack the capacity to make particular decisions. In this study the group who lacked capacity were an elderly group with dementia common. This process raised a dilemma about how a patient without capacity to make a refund application can then manage the money claimed on their behalf and whether guardianship safeguards are necessary.

Objective: The aim of this study was to determine the prevalence of risk factors for physical illness in a long stay psychiatric unit, where all care (both psychiatric and physical) is provided by the psychiatric team.

Method: All patients in the long-stay ward had a full physical examination including calculation of BMI. All patients had blood sampling including FBC, U&E, LFTs, TFTs, lipid profile (total cholesterol, triglycerides, HDL and LDL), glucose, HbA1c, and prolactin. ATP111 criteria were used to determine the presence of the metabolic syndrome.

Results: We found the mean number of comorbid medical diagnosis was 2.7. The prevalence of metabolic syndrome was 40.7% (44.4% of females and 24.1% of males). The prevalence of obesity was 51%, and 51% also had a total cholesterols in excess of 5.0mmol/l. Prolactin was elevated in two-thirds of female patients.

Conclusion: We conclude that the annual physical examination is of limited value in long-stay psychiatric unit. The high prevalence of physical illness and physical risk factors warrants primary care involvement in screening and treatment of long-stay psychiatric patients.

Objective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.

Hepatitis B surface antigen and antibody to hepatitis B core antigen were measured in 232 long-term psychiatric patients. The aims of the study were to determine the prevalence of infection and to relate it to factors such as age, sex, duration of hospital stay and diagnosis.

There was both an increased rate and increased evidence of past infection amongst the patients tested relative to the general population. There was no statistical significant difference between the antibody positive group compared to the antibody negative group for age, sex and duration of hospital stay, unlike that found in studies of mentally handicapped patients. There was a positive association between the presence of antibody and patient diagnosis. Patients with mental handicap appear to have a predilection for hepatitis B.

Further work needs to be done to elucidate the epidemiology of hepatitis B in psychiatric patients and evaluate the reservoir of infection present.