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.

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.

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: 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.

Objective: This study aims to identify and review available evidence in the literature to determine the strength of association between antipsychotic medications and thromboembolism as an adverse effect.

Method: Electronic databases were searched for evidence.

Results: A total of 15 case reports, 14 case series, two observational studies and three case-control studies were found in the literature. Two case control studies found significantly increased risk of venous thromboembolism (OR 13.3 and 7.1 respectively). The risk was high for low potency antipsychotics. Studies were critically appraised to determine the strength of evidence.

Conclusion: The studies reviewed indicate a significant association between antipsychotics and venous thromboembolism. Patients using the antipsychotics and those who prescribe them should be aware of this association.

Objectives: De-institutionalisation and the expansion of community services have resulted in a reduction in the number of inpatient admissions in Ireland having fallen by 31% between 1986 and 2006. However, despite this, readmissions continue to account for over 70% of all admissions. The policy document A Vision for Change identified many shortcomings in the current model of provision of mental health services, making recommendations for the future development of community-based services with emphasis on outreach components such as homecare, crisis intervention and assertive outreach approaches. These recommendations are reviewed in relation to readmissions and the impact they may have on reducing the revolving door phenomenon.

Method: Three main intervention programmes essential to the delivery of an effective community-based service outlined and recommended by A Vision for Change, along with other pertinent factors, are discussed in relation to how they might reduce readmissions in Ireland. A series of Pearson correlations between Irish inpatient admissions rates and rates of outpatient attendances and provision of community mental health services are carried out and examined to explain possible relationships between increasing/decreasing admission rates and provision/attendances at community services. International literature is reviewed to determine the effectiveness of these intervention programmes in reducing admissions and readmissions and their relevance to the Irish situation is discussed.

Conclusions: Whilst A Vision for Change goes a long way towards advocating a more person-centred, recovery oriented and integrated model of service delivery, it is apparent from the consistently high proportion of readmissions in Ireland that there are still many shortcomings in service provision. The availability of specialised community-based programmes of care is as yet relatively uncommon in Ireland and uneven in geographical distribution. A considerable improvement in their provision, quantitatively and qualitatively, is required to impact on the revolving door phenomenon. In addition a re-configuration of existing catchment populations is required if they are to be successfully introduced and expanded.

In 1960, Thomas Szasz published The Myth of Mental Illness, arguing that mental illness was a harmful myth without a demonstrated basis in biological pathology and with the potential to damage current conceptions of human responsibility. Szasz's arguments have provoked considerable controversy over the past five decades. This paper marks the 50th anniversary of The Myth of Mental Illness by providing commentaries on its contemporary relevance from the perspectives of a range of stakeholders, including a consultant psychiatrist, psychiatric patient, professor of philosophy and mental health, a specialist registrar in psychiatry, and a lecturer in psychiatry. This paper also includes responses by Professor Thomas Szasz.

Szasz's arguments contain echoes of positivism, Cartesian dualism, and Enlightenment philosophy, and point to a genuine complexity at the heart of contemporary psychiatric taxonomy: how is ‘mental illness’ to be defined? And by whom? The basis of Szasz's doubts about the similarities between mental and physical illnesses remain apparent today, but it remains equally apparent that a failure to describe a biological basis for mental illness does not mean there is none (eg. consider the position of epilepsy, prior to the electroencephalogram). Psychiatry would probably be different today if The Myth of Mental Illness had not been written, but possibly not in the ways that Szasz might imagine: does the relentless incarceration of individuals with ‘mental illness’ in the world's prisons represent the logical culmination of Szaszian thought?

In response, Professor Szasz emphasises his views that “mental illness” differs fundamentally from physical illness, and that the principal habits the term ‘mental illness’ involves are stigmatisation, deprivation of liberty (civil commitment) and deprivation of the right to trial for alleged criminal conduct (the insanity defence). He links the incarceration of the mentally ill with the policy of de-institutionalisation (which he opposes) and states that, in his view, the only limitation his work imposes on human activities are limitations on practices which are conventionally and conveniently labelled ‘psychiatric abuses’.

Clearly, there remains a diversity of views about the merits of Szasz's arguments, but there is little diminution in his ability to provoke an argument.

Absinthe is an alcoholic drink which is becoming more widely consumed after being banned for many decades. An association between absinthe use and psychiatric symptoms, ranging from impairment of concentration to marked hallucinations and seizures, has been suggested, but evidence remains unclear. Thujone, identified as a possible psychoactive ingredient, has recently been implicated in absinthe's putative neuropsychiatric effects. This report presents a case where acute suicidality emerged during absinthe consumption; possible neurobiological aetiological mechanisms and the history of absinthe use and associated adverse effects are reviewed.

Tardive dyskinesia is a neurological disorder characterised by involuntary and purposeless movements affecting any part of the body. These movements typically occur in the oro-facial area and the patient is usually unaware of them. There are inconsistent findings in the literature on the risk factors for developing tardive dyskinesia. Nevertheless, previous reports indicate that tardive dyskinesia is more common in female patients, patients with a history of alcohol and substance misuse, affective disorders, and intellectual disability. The dose, class and duration of antipsychotic nmedication may also be independent risk factors. We report on the case of a patient who developed tardive dyskinesia on a low dose of the second generation antipsychotic risperidone.

The adverse effects of marijuana are well documented, as well as its positive therapeutic uses. Cannabis has traditionally been associated with an antiemetic action following acute ingestion and synthetic cannabinoids have an established use as antiemetics for chemotherapy induced nausea. However, there has been limited recognition of chronic cannabis use as a cause of cyclic vomiting syndrome. Cannabinoid hyperemesis was first identified by Allen er al in 2004. Compulsive bathing was also described as part of the clinical picture. This same syndrome has been confirmed a number of times in the medical literature in the interim. The condition has, to our knowledge, never been reported, in a psychiatric patient.

The word ‘adherence’ refers to the provision of consistent support (eg. for a political party or religion) or the act of holding particular elements together (eg. in constructing a building). In the medical context, adherence refers to the extent to which patients take their medications as prescribed. While the terminology related to medical adherence has changed significantly over the past two millennia, the core issue has not. Most recently, the term ‘adherence’ has replaced the term ‘compliance’, although it still jostles with ‘concordance’ in a growing literature which focuses now, as always, on one key question: why do so many people seek treatment for illness but then decide not to take their prescribed medication? This is an important question, both in terms of public health and societal cost: in the US, up to 50% of patients do not take their prescribed medications, resulting in additional healthcare costs of $290 billion per year. The greatest cost of non-adherence, however, relates to prolonged illness, increased rates of relapse and reduced wellness.