Objective: To review the evidence guiding conventional and atypical depot neuroleptic usage.

Method: A search of biomedical electronic databases including Medline, Embase, PsychInfo and Cochrane was performed. Hand searching of journals was also carried out.

Results: Depot neuroleptics are safe and effective in the maintenance treatment of patients with schizophrenia. There is some evidence to support the use of depot neuroleptics in illnesses other than schizophrenia. The evidence base guiding depot usage is sparse.

Conclusions: Although guidelines are emerging there is a pressing need for rigorous well designed trials of depot antipsychotic usage. The advent of atypical depot antipsychotic preparations should stimulate research in this important area of clinical practice.

Objectives: Psychological services to patients with cancer are very limited in Ireland. A dedicated psycho-oncology service was established at our Institution 18 months ago. The aim of this study was to examine referral rates, psychiatric diagnoses and treatment interventions in this patient group.

Methods: The clinical and psychiatric characteristics of consecutive patients (n = 63) referred to a recently established specialist psycho-oncology service in an Irish university teaching hospital over a one-year period were examined prospectively. International diagnostic criteria were applied. Forms of treatment instituted and clinical response to same were also audited.

Results: Over half (54%) of patients presented with affective disorder spectrum illnesses. The remaining referrals represented a diverse group of psychiatric diagnoses, but included a large proportion of patients with delirium. Approximately 20% of patients did not meet criteria for a psychiatric diagnosis. There was an over-representation of breast cancer and lymphoma. Thirty-eight per cent of patients were on prescribed corticosteroids at the time of referral. Eighty-two per cent of patients required some form of psychiatric intervention, and 86% of these benefited clinically from our intervention.

Conclusions: The data suggest that even in oncology services with good existing support networks, such as this one, the role of an additional input from liaison psychiatry is considerable.

Objectives: Psychiatric disorders are common and frequently undetected and under treated in the palliative care population. The aims of this pilot study were determine to: (1) the incidence of psychiatric co-morbidity; (2) the patient's current insight; (3) future fears regarding symptom control; and finally (4) the degree of satisfaction with their doctors level of communication, at the time of their diagnosis.

Methods: Over a six-month period, 100 consecutive hospice admissions were assessed by AP, within 72 hours of their arrival. This patient group all had advanced malignant disease. A semi-structured questionnaire was used as a guide (see Table 1) to interview. A full history, cognitive and Mental State Examination (MSE) were performed on each patient.

Results: Sixty-four patients were interviewed, 36 were excluded. Sixteen (25%) had a depressive illness, six (9%) had anxiety, 56 (88%) had full or partial insight into their illness. Only eight (12%) were unaware of the nature or implications of their disease. Of those who responded, 19 (30%) felt dissatisfied with how their doctors communicated their diagnosis. A significant proportion, 30 (47%) felt that eventually their symptoms would become out of control.

Conclusions: This was a pilot study by a psychiatrist at the bedside in the hospice setting. We found that by concentrating on psychological symptoms rather than the biological, a diagnosis of depression was possible even in these complex medical patients. However, recognition of treatable anxiety in this population is a challenge. Even though 30 (47%) felt that their most distressing symptoms would become out of control during the course of their illness, we found an incidence of anxiety of only six (9%). This suggests that our interview underestimates the true level of anxiety in these patients, and highlights the need for a low threshold for diagnosis and possibly an objective screening mechanism. Regarding the ‘breaking of bad news’, 19 (31%) of patients were dissatisfied and unhappy with this experience and there is clearly room for improvement in communicating a diagnosis of malignancy.

Objective: Post-traumatic stress disorder (PTSD) is one of the most prevalent psychological disorders. Methods to alleviate its symptoms range from ‘talking therapies’ to pharmaceutical interventions. Our objective was to carry out a systematic review of the effectiveness of sertraline, an SSRI, as a treatment for PTSD.

Method: Databases were searched to identify relevant research on sertraline as a treatment for PTSD.

Results: Five randomised control trials were identified, along with seven open trials and case series studies.

Conclusions: The review and meta-analysis supported the use of sertraline for PTSD though further research on sub-group differences (eg. gender) is required.

Objectives: To evaluate the effect of a risk assessment tutorial on the adequacy of case note documentation in a general adult psychiatry setting.

Methods: A comparison of case note documentation of risk factors for violence prior to and subsequent to a risk assessment tutorial.

Results: Prior to the tutorial there were very low rates of documentation of risk of violence. Subsequent to the tutorial, statistically significant improvements in documentation occurred in approximately one third of the items being assessed. Significant improvements occurred in the following; recording a collateral history (from 18%-36%) and previous history of deliberate self harm (from 24%-50%), noting emotions related to violence in the mental state examination (from 2%-24%) and documenting a risk management plan (from 2%-28%). However, levels of documentation remained overall sub-optimal.

Conclusions: Some improvement in case note documentation can result from providing tutorials in risk assessment. However, the ideal format for teaching risk assessment needs to ascertained.

Recent years have seen renewed emphasis on the importance of mental health policy as a key component of health and social policy at both national and international levels. In 2001 the European Commission produced a public health framework for mental health in the EU. In the same year, the World Health Organisation devoted its annual health report to mental health and called on countries to formulate, update and implement mental health policies. The EU and WHO initiatives both recognised that the challenges facing mental health policy makers are increasingly transnational in scope, related to issues such as rapid demographic change, increased transnational migration, the protection of human rights and the implementation of a growing number of international laws, directives and protocols in relation to mental health care.

Significant progress has been made in the development of Irish mental health services over the past 40 years. Nevertheless, many challenges remain. The aims of this paper are to outline:

• Prevailing theoretical perspectives on mental health policy

• Mental health policy in Ireland since the last major policy revision in 1984

• Relevant economic and demographic changes in Ireland since 1984

• Relevant clinical, legislative and policy developments in relation to mental health

• Future directions for mental health policy.

Electronic literature searches were performed using Psyclit (American Psychological Association, 1887–2003), Medline (United States National Library of Medicine, 1985 – 2003), with broad search terms related to mental health policy. Additional books and papers were identified by tracking back through references and consulting with colleagues. Policy documents and selected literature on Irish psychiatric services were reviewed and related to recent literature on mental health policy.

People with obsessive-compulsive disorder (OCD) typically experience their relationships with others with a high level of trepidation and bring their anxieties into their work with professionals. We have written this paper to describe experiences of working with people with diagnoses of OCD and the impression that we have formed about the kinds of relationship that builds up in the early stages of this work. We believe that it is important to consider the quality of these professional relationships because of their impact on the patient's ability to benefit from whatever intervention we propose. Here, we place particular attention on the roles of magical thinking, disturbed relationships and the fear of rejection. The perspective presented here is designed to complement those of other approaches to OCD – including the neurological, behavioural and cognitive-behavioural. The following themes relating to the social and interpersonal experiences of people with OCD are examined here: (a) their general tentativeness and uncertainty in social interactions, (b) their fear of being damaged by others in social interactions, (c) their magical thinking relating to damaging others.

Selective serotonin reuptake inhibitor induced mania has been described in adults, and more recently in adolescents. To the authors' knowledge a case in pre-adolescents has not yet been published in the literature. The authors would like to report two cases of SSRI-induced mania. Both cases were pre-adolescent girls, A and B, who had a DSM-IV diagnosis of panic disorder, and were treated with paroxetine.

In 1841 Dr Samuel Hitch organised a meeting at Gloucester Lunatic Asylum during which a decision was taken to establish the Association of Medical Officers of Asylums and Hospitals for the Insane with a view to “improvement in the management of such institutions and the treatment of the insane, and the acquirement of a more extensive and more correct knowledge of insanity”. From the six medical officers present at this historic meeting the membership of The Royal College of Psychiatrists has grown to more than 11,000, of whom over 1,500 practise overseas. Dr Mike Shooter (President) believes that the College's most important, and painful, transformation has been from a largely educational to a political organisation.

Within psychiatric practice, psychotherapy occupies a unique role. Not only is it a mode of treatment for some patients, it is also an explanatory model; not only is the psychotherapist called upon to fulfil numerous overt functions within the institution, there are also all sorts of other functions which a psychotherapist may be called upon or expected to fulfil, some more welcome and appropriate than others.

Within medicine the choice of becoming a psychiatrist is often seen as feminine, unscientific, perhaps unsafe and slightly illicit. The same applies within psychiatry, to the choice of psychotherapy, and the decision to leave behind dopamine and clozapine for immeasurable, bizarre, unconscious objects. This paper will describe some of the overt and covert roles in the life of a consultant psychotherapist within the National Health Service (NHS) and then in more detail elucidate these roles with two examples from clinical practice.

We wish to describe a case of gamma hydroxyl butyrate (GHB) withdrawal, including seizure activity in a 34 year old male, who had been taking the substance over a two year period. The syndrome has many aspects in common with alcohol withdrawal (delirium tremens) and benzodiazepine withdrawal (long duration of symptoms), however detoxification presents many challenges for clinicians.

Luis Simarro, Santiago Ramón y Cajal and Joaquín Sorolla were friends who cultivated art and science in an unhappy Spain. Simarro was the country's leading psychiatrist at the turn of the 20th century, Ramón y Cajal, or simply Cajal as he came to be known in the wider world won the Nobel Prize for his work on the nervous system, and Sorolla is remembered as ‘the Velázquez of light’. All three felt a deep love of Spain and strove to bring freedom, science and the light of truth to their countrymen, each in his own unique way.

Robert Walser (1878-1956), one of the great literary geniuses of 20th century German literature, was also one of the most mysterious writers of his time. Born in Switzerland in 1878 he was diagnosed with schizophrenia at the age of 50 and spent the remaining two and a half decades of his life in Swiss psychiatric hospitals until his death in 1956. His literary legacy consists of four novels, numerous pieces of short prose (essays and stories) as well as 526 pages of pencil notes written in minuscule script, the famous ‘micro-gramms’.

Although highly unsuccessful during his lifetime and leading the life of an artist on the margins of society, his writings have been linked to Kleist, Kafka, Joyce and Beckett. The silencing of Walser's unique voice by mental illness and his disappearance behind the walls of psychiatric hospitals has been considered a tragedy and over the years doubts were raised about the true nature of his illness.