This paper will bring you on a polemical journey to understand the issues related in conceptualizing bereavement-related depression.

A critical narrative review was carried out to evaluate arguments and controversies surrounding DSM-IV classifications of bereavement exclusion for the diagnosis of major depressive disorder (MDD).

Available studies that are associated with bereavement exclusion criteria, the open trials and treatments with the implications of such conceptualizations and the current removal of the bereavement exclusion from MDD in DSM-5 were addressed.

The review highlights the never-ending polemical journey of conceptualizing any mental disorders, bereavement-related depression included.

This study sought to ascertain the prevalence rates and risk factors for a range of mental health difficulties, including suicidal ideation/self-harm among 16 and 17-year-old rural Irish adolescents, a vulnerable group in transition from childhood to adulthood.

Adolescents (n=237) took part in this cross-sectional study. Participants completed a questionnaire compendium consisting of generic questions on demographic information, use of mental health services and four normed questionnaires: The Youth Self-Report, the Children’s Depression Inventory, the Coping Inventory for Stressful Situations-Adolescent and The Family Assessment Device.

We found that 16.9% of adolescents reported clinically significant mental health difficulties. Significant gender differences were found on internalising and externalising difficulties. There were no gender differences in suicidal ideation or self-harm. Only 3.4% of adolescents were receiving professional help for mental health difficulties. Multiple regression analyses revealed that family dysfunction, emotion-focussed coping and poor academic competence were significant predictors of poorer mental health difficulties in both genders. Family dysfunction was the strongest predictor of mental health difficulties in males. Among females, emotion-focussed coping was the strongest predictor of internalising difficulties and depression. Social diversion (social support) was predictive of less internalising difficulties and depression for females.

The study shows that a significant number of Irish 16 and 17 year olds have mental health difficulties, yet very few are receiving treatment. Emotion-focussed coping, family dysfunction, poor academic competence and less social support were important predictors of mental health difficulties. A new finding is the stronger association that family dysfunction has with poorer mental health in males than females, when controlling for academic competence and coping skills. The findings may have implications for psychological interventions.

Childhood sexual abuse has previously been associated with adult mental health difficulties, however, few studies have evaluated all forms of childhood maltreatment in individuals attending adult mental health services. Consequently, this study investigates the association of five forms of childhood trauma with a range of clinical symptoms and mental health disorders in 136 individuals attending a mental health service in Ireland utilising the Childhood Trauma Questionnaire (CTQ).

One hundred and thirty-six patients attending the Roscommon Mental Health Services completed the CTQ and a number of additional psychometric instruments evaluating illness severity, impulsivity, disability and the presence of a personality disorder(s) (PD) to ascertain the prevalence of childhood trauma and any potential associations between childhood trauma and a range of demographic and clinical factors.

Seventy-six per cent of individuals reported childhood trauma, with emotional neglect most frequently reported (61%). Individuals who had experienced childhood trauma had higher rates of clinical symptoms, distress and impulsivity. Substance abuse and paranoid, borderline and antisocial PDs most associated with childhood trauma.

This study demonstrates the need to routinely elicit information on all forms of childhood traumatic experiences from patients.

This paper aims to show how effective teamworking can be achieved in Community Mental Health Teams (CMHTs), in the context of recovery-focused care.

A narrative review of various governmental policy documents and selected papers relevant to teamworking and recovery-focused care within mental health services, in an Irish context.

Effective teamworking within CMHTs is a prerequisite to the provision of quality, recovery-focused care. It requires the management of various environmental (e.g. adopting a ‘recovery’ model of mental health), structural (e.g. sharing of responsibilities and capabilities) and process (e.g. utilising a clear referral pathway) factors that influence teamworking, as CMHTs develop over time.

Completion by CMHT members of teamworking and other evaluative measures can assist teams in highlighting potential interventions that may improve recovery-focused team functioning and effectiveness.

1) to assess compliance with the Data Protection Acts (DPA) by a Department of Psychiatry in a general hospital, 2) to implement measures that are likely to maximize compliance with the hospital data protection policy, 3) to close the audit cycle by assessing the impact of such measures on departmental compliance with the DPA over five months period.

An individual, anonymised staff questionnaire on data collection practices, procedure of disclosure of data to third parties and previous training on DPA was used to collect information from the department staff. The premises were inspected at different times over a week period using structured checklist. Default points were recorded during each inspection. Post-audit interventions included a mixture of educational interventions and practical solutions. A re-audited took place five months later using the same method.

The baseline audit demonstrated significant lack of compliance with the DPA among staff members and lack of staff training on the DPA. Following the interventions, staff awareness of the requirements of the act rose which in turn lead to better adherence to recommend practices in data handling and to mean default points dropped significantly. Management of manual files appears to constitute the biggest problem in this audit. Daytime breaks were found to pose higher risk to stored data compared with before and after working hours.

A combination of educational and practical interventions including training of staff on the DPA results in overall improvement in compliance and reduction in default points. However, management of manual (physical) data proves to be more difficult and hence will need more input.

Deaths by suicide have been increasing in recent years in Ireland, many of whom have co-morbid mental health difficulties and/or have attended primary care services 1 month before death.

To profile how ‘Access to Psychological Services Ireland’ (APSI) provides stepped-care therapies for mild-to-moderate adult mental health presentations and the potential effectiveness of this model based on comparison to a review of evidence-based strategies in suicide prevention. A secondary aim is to highlight how APSI has the potential to target those at risk of suicide and provide an integrative after-care service to complement secondary care mental health services.

In a context of inter-agency working, APSI provides an integrated continuum of suicide prevention interventions that map onto or intervene across the continuum of suicide behaviour. Hence, APSI appears to implement what the literature suggests will work in preventing suicide. However, outcome research is needed to establish APSI’s impact in preventing suicide.

It is recommended that Irish-based research is conducted to establish APSI’s impact in preventing suicide with a view to rolling out APSI as a national mental health clinical care programme.

Mental disorder is common among individuals with neurological illness. We aimed to characterise the patient population referred for psychiatry assessment at a tertiary neurology service in terms of neurological and psychiatric diagnoses and interventions provided.

We studied all individuals referred for psychiatry assessment at a tertiary neurology service over a 2-year period (n= 82).

The most common neurological diagnoses among those referred were epilepsy (16%), Parkinson’s disease (15%) and multiple sclerosis (8%). The most common reasons for psychiatric assessment were low mood or anxiety (48%) and medically unexplained symptoms or apparent functional or psychogenic disease (21%). The most common diagnoses among those with mental disorder were mood disorders (62%), and neurotic, stress-related and somatoform disorders, including dissociative (conversion) disorders (28%). Psychiatric diagnosis was not related to gender, neurological diagnosis or psychiatric history.

Individuals with neurological illness demonstrate significant symptoms of a range of mental disorders. There is a need for further research into the characteristics and distribution of mental disorder in individuals with neurological illness, and for the enhancement of integrated psychiatric and neurological services to address the comorbidities demonstrated in this population.

Gamma-butyrolactone/gamma-hydroxybutyrate (GBL/GHB) and related analogues are increasingly misused. The study reports on patient characteristics, nature and pattern of use, complications and comorbidity for a cohort of patients presenting to a large Substance Misuse Service in Brighton and Hove City.

A retrospective case-note review of routinely collected clinical data on patients with primary GBL/GHB misuse.

In all, 24 individuals were male and 3 female, with a mean age of 34 years. A total of 21 males identified themselves as gay and 1 female as bisexual. Just over half (15, 56%), respectively, were living in stable accommodation and were in employment or third-level education. In all, 22 (81%) met criteria for physical dependence and two-thirds (18, 67%) had experienced overdose. The group was using large amounts of GBL (mean 53 ml/day) with a significant number (25, 93%) using ‘around the clock’ (every 1–3 hours). Over one-third (10, 37%) had a diagnosis of HIV and with 24 (89%) having a presumptive diagnosis of anxiety disorder.

A profile of gay men with relatively stable lifestyles, but nevertheless with a high rate of complication of GBL/GHB use and with a significant comorbidity (HIV and psychological problems) was identified. The need for integrated specialist services and the importance of liaison with Emergency Departments and HIV services is highlighted.

Suicide is a major public health problem, with mental disorders being one of its major risk factors. The high incidence of suicide on the Isle of Wight has motivated this study, the first of its kind on suicide in this small geographic area.

The aim of the study was to identify socio-demographic and clinical risk factors for suicide in the population of service users and non-service users, and gender-related characteristics of suicidal behaviour in a limited geographic region.

Data were collected on 68 cases of suicide (ICD-10×60-X84) from residents of the Isle of Wight District between January 2006 and December 2009. All data were statistically analysed using Pearson’s χ2 test and Yates’ correction for continuity.

The mean annual suicide rates over the period were 5.65 per 100 000 for women and 19.28 for men. Significantly (p=0.0006), more men than women (male/female ratio 3:1) died as a result of suicide. Relatively (p=0.07) more women (56.2%) than men (32.7%), and significantly more (p=0.05) service users (45.3%) than non-service users (13.3%) were unemployed. Significantly, more (p=0.0006) service users (64%) than non-service users (20%) had a history of suicide attempts and relatively (p=0.06) more (50.9%) service users than non-service users (20%) had attended the accident and emergency department before their death; 69% had an adverse life event within a year before their suicide. Depression as the most common Axis-I illness was diagnosed in 36% of all; but significantly (p=0.008) more in women (66.6%) than men (17.3%). Relatively (p=0.07) more women (56.2%) than men (32.7%) have contacted services before their death. Suicide by hanging was the most common cause, accounting for the death of 71% of men and 50% of women.

The study found that 80% of all suicides occurred in people suffering from mental disorder. Men are at a significant risk of suicide. Depressive disorders in women and stress-related disorders in men were the most common mental disorders. Treating mental disorders and co-morbid conditions seems to be one of the key elements in suicide prevention strategies.

We present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.

Case Report.

The case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.