Objectives: To examine a sample of adults with mental health disorders attending at an area psychiatric service, for the presence of impairments in language, communication and swallowing, using a test battery administered by speech and language therapists.

Method: The study surveyed a randomly selected sample (n = 60) of patients from an acute psychiatric inpatient unit and associated community services, using several standardised measures of language, communication and swallowing.

Results: On this test battery, over 80% (50/60) of subjects studied demonstrated impairment in language; while over 60% (37/60) presented with impairment in communication and discourse. Over 30% (18/58) of subjects assessed showed some impairment in swallowing.

Conclusion: Use of this test battery confirmed the presence of language, communication and swallowing impairments in many patients in this sample of attenders at a general psychiatry service. We suggest that this study provides evidence for a (currently unmet) need for specialist speech and language therapy assessment and support among this patient population.

Objectives: Historical information is central to decision making in mental health care. Clinical information in the Irish mental health services is currently mostly paper based. Mental health care in Ireland has moved from an institutional medical model towards a community based multidisciplinary model in recent years. This change has resulted in a dispersal of information between multiple sites and professionals, rendering it less accessible, particularly in emergency settings.

This study sought to find out if psychiatrists working in Ireland were experiencing information problems, their ideas about and attitudes towards electronic solutions to these problems, and their views as to what particular pieces of information are indispensable in emergency mental health assessments.

Method: A questionnaire was designed to answer these questions and sent to a representative sample of 150 psychiatrists working in Ireland.

Results: One hundred and nineteen questionnaires (79.3%) were returned complete. Of the 119 respondents 98(82.4%) stated that they had performed emergency mental health assessments within the past year without access to key information and 79(66.4%) said they would have made different decisions in some cases had they had all the available information. Information deficits were particularly apparent in liaison and forensic psychiatry.

Of the respondents 110(92.4%) stated that they would welcome an electronic database designed to support emergency mental health assessments. Misgivings were expressed regarding forms of consent, data quality, breach of confidentiality, resources and much more. Risk factors (ie. self-harm potential), a high alert message and medication details were the data items thought to be most critical.

Conclusions: A shareable set of essential pieces of information (a minimum data set) would offer a balance between patient safety, confidentiality and shareability. A wider debate about solutions to the information deficits in mental health care in Ireland needs to take place among all stakeholders so that this idea can be moved forward.

Objectives: National Institute of Clinical Excellence guidelines indicate that pre-surgical assessment of patients wishing to undergo bariatric surgery should include consideration of psychological factors. This paper describes the psychological characteristics of a cohort of 59 patients.

Method: Patients were interviewed and completed the following psychometric assessments: the Hospital Anxiety and Depression Scale, the Dieting Belief Scale, the Binge Eating Scale, the Emotional Eating Scale, the Generalised Self Efficacy Scale, and the Social Support Questionnaire.

Results: High levels of psychological distress and binge eating were reported. Men more commonly reported a history of alcohol misuse. There was evidence to suggest that psychological distress predated obesity in the majority of cases.

Conclusion: Compulsive eating leading to obesity appears to be both a consequence and a cause of psychological distress. Replacing compulsive eating represents a major post-surgical challenge in the majority of cases. Psychological assessment and follow-up should be offered to each patient.

Recent reports from the Inspector of Mental Health Services have highlighted marked variations in electroconvulsive therapy (ECT) prescriptions nationally. This article reviews six international guidelines in order to assess the question of which patients should be referred for ECT treatment and at what stage in their illness. The guidelines display a general consensus in terms of the acutely and severely ill, but differ dramatically in terms of access to ECT outside this category, such as the moderately depressed patient who is treatment resistant but non-psychotic and non-suicidal and who requests ECT due to a previous good response.

The American Psychiatric Association guidelines strongly support the early consideration and use of ECT, highlighting the dangers associated with increased length of illness for individual prognosis. The National Institute of Clinical Excellence (UK) guidelines are the strictest, reserving ECT for the severely ill exclusively and only in cases with a demonstrable failure of alternative treatments. This confusion may ultimately need to be addressed by the Mental Health Commission as data relating to variations in practice may result in inappropriate reductions in access to an established treatment.

The Richmond Asylum (St Brendan's Hospital) in Grangegorman, Dublin was established in 1815 to help address the unmet needs of the mentally ill in 19th century Ireland. This paper examines the Richmond Asylum Joint Committee Minutes from 1907 in order to explore specific aspects of management and clinical activity at the Richmond Asylum, including: (a) patient populations in the asylums; (b) staffing and management issues; (c) challenges presented by workhouse populations in the early 20th century; and (d) the clinical ‘segregation’ of patients performed by the Medical Superintendent, Dr Conolly Norman, in 1907.

Disulfiram is widely used for the aversive treatment of alcoholism. It is well tolerated in most patients; however 1:15,000 will develop peripheral neuropathy, which is frequently misdiagnosed as alcoholic neuropathy. Most cases present with a motor-sensory neuropathy of the lower limbs, which tends to improve when administration ceases, though some cases may be left with permanent sequelae. This adverse reaction can be avoided by using the lowest effective dose. A literature review using the Medline revealed 66 citations relating disulfiram to peripheral neuropathy, and the number of cases reported is small.

We describe a young African male presenting to an Irish psychiatric service with first episode psychosis with an acute onset, no prodromal features and early and complete remission. Migrant and ethnic minority groups may differ in their clinical presentation, course and outcome of psychosis compared with the Caucasian population. This has implications for assessment and treatment of ethnic minority patients in an Irish context given the recent migration into a previously homogeneous population.

A 35-year-old South Asian Muslim male was admitted for acute psychotic episode to an urban acute psychiatric unit. In the context of ongoing religious delusions, and on his request to fast during the Islamic month of Ramadan we made alterations to his medication dosing schedule. We discuss the clinical implications of such practice.

We describe two cases reports, demonstrating an association between clozapine treatment and stuttering. Stuttering in both cases was dose-related and a significant improvement was noted when the dose of clozapine was reduced.