Objective: Long waiting lists have a negative impact on client satisfaction, staff moral and referrer's opinion of the service. The aim of this project was to decrease a waiting list from a maximum wait of more than one year to a wait of no more than six weeks.

Method: We introduced three simultaneous initiatives to decrease a long waiting list; (i) an individually led triage system (ii) setting-up an attention deficit hyperactivity disorder (ADHD) specialist team and (iii) division of the residual waiting list between team members. These initiatives were introduced and analysed over a ten month period. The study period ran from 1/3/2004 to 31/12/2004.

Results: The waiting time to first appointment was significantly reduced. At the beginning of the study there were 62 people waiting to be seen and each had waited an average of 122 days with a waiting time range of 0-449 days. At the end of the study, there were 19 people waiting with a mean waiting time of 19 days and a range of 0-168 days.

Conclusions: The single most powerful intervention was the triage system. The ADHD clinic allowed referrals to be streamlined in a very structured and efficient way. The division of the residual waiting list was not as onerous as it first appeared. The service saw more referrals then ever during the study period. Referrers and families appreciated being seen more quickly. By removing the burden of the waiting list from staff the potential for creative thinking around further development of the service increased.

Objectives: To carry out a survey on the use of video conferencing equipment by a rural child psychiatric multidisciplinary team and to determine what impact the introduction of this equipment had on service provision.

Method: Several aspects were studied including user satisfaction and estimations of cost saving, on the basis of avoidance of travel to and from the regional base in Galway. A questionnaire was also developed to determine whether alternative contact would have been made if if this new technology were not in place.

Results: The results of the initial six months following commencement were investigated. Use of the equipment was attempted 17 times during this period. Most members of the child psychiatry team participated in its use. Visual problems accounted for 66.7% of reported technical difficulty and 88.9% of users rated their level of satisfaction with the equipment as ‘Satisfied’ or ‘Very Satisfied’.

Conclusions: Apart from the start-up cost implications of installing this equipment, it satisfied its aim of increasing contact between the rural service and St Anne's Children Centre in Galway. The equipment was easy to use and for the most part reliable.

Objectives: To review the literature on older people with enduring or recurrent severe mental illness with an onset earlier than 65 years (graduates) and, in particular, to look at the specific features and needs of this group.

Method: A Medline literature search produced 41 relevant papers and reports on the subject.

Results: There are a substantial number of older people with severe mental illness and the number will rise in line with increased longevity. As they age these patients' psychiatric disabilities are compounded by medical and social problems. The move to community based care has largely ignored the needs of graduates who were previously cared for in psychiatric institutions.

Conclusion: There is an urgent need to plan and develop adequate services for this vulnerable group.

Objective: Media portrayals of mental illness and psychiatry have a considerable impact on public perceptions of mental health issues. This paper aims to focus on portrayals of psychiatry and psychiatrists in four contemporary Irish feature films in order to make wider points on this theme.

Methods: Contemporary Irish feature-films that made substantial reference to psychiatry, psychiatrists or mental health in Ireland were identified though electronic searches and consultation with the Film Institute of Ireland. Selected films were viewed. Electronic searches were performed in the medical and film literatures, with broad search terms related to film, psychiatry, psychiatrists or mental health in Ireland. Additional books and papers were identified by tracking back through references and consulting with colleagues.

Results: The portrayal of psychiatrists in film is closely related to the development of both twentieth century psychiatry and twentieth century cinema. In common with recent European films, certain recent Irish films have tended to show psychiatrists as sympathetic, humane individuals (with some notable exceptions). While there have been a number of portrayals of dissocial personally disorder and various states of chronic alienation in recent Irish film, there have been fewer portrayals of psychosis or learning disability. Recent Irish films emphasise the role of alcohol in causing and perpetuating psychological distress. They generally provide unflinching portrayals of the effects of psychological distress and alienation, suicide and substance abuse at individual, family and community levels; nonetheless, there is still a regrettable tendency for films to associate mental illness with dissocial behaviour.

Conclusions: The portrayal of mental health issues in film presents both challenges and opportunities to film-makers, mental health service-users and general audiences alike. It is to be hoped that the recent trend towards realistic explorations of mental health issues in many European films continues into the future. Increased research in this area would help clarify the role of cinema in shaping public understandings of mental illness, and may also help identify additional ways of addressing stigma in the future.

We report on the case of a 15-year-old boy referred to Warrenstown inpatient unit for management of what appeared to be a typical case of anorexia nervosa. Over the course of his admission however, this diagnosis was no longer considered appropriate and substituted for a food avoidance emotional disorder. This is one of a number of cases of young males who have recently been referred for inpatient management of anorexia nervosa but which emerged into something quite atypical. The limited usefulness of the ICD-10/DSM-IV criteria in the diagnosis of an eating disorder in childhood and adolescence in this case reflects a broader level of discontent with the application of such diagnostic classification systems in a paediatric population.

Objectives: Second opinion is a medical opinion provided by a second physician/ medical expert after first receiving an opinion by another physician/ medical expert. Little is known about the provision of second opinion in Child and Adolescent Mental Health Services (CAMHS). This study describes the second opinion service provided by the Child and Adolescent Mental Health Services (CAMHS) in the South Wales region.

Methods: We undertook a survey of a second opinion service in Child and Adolescent Mental Health Services (CAMHS). We also assessed whether the recommendations made by the second opinion clinic were implemented by the referrers.

Results: The diagnoses were not changed in 68% of the cases but alternative treatments were suggested. In 90% of the cases the treatment recommended by the clinic was implemented and nearly 70% of the patients showed improvement with the recommended treatment.

Conclusion: A second opinion service can provide valuable support and expertise to CAMHS and the referred families.

We describe a 63 year old male with serotonin syndrome, presenting with choreoathetosis. Differentiating this syndrome from neuroleptic malignant syndrome remains a challenge. It is important to be aware of drugs that can potentially precipitate this syndrome.

The lifetime prevalence of bipolar affective disorder is between 1 % and 2%. This educational review paper focuses on two areas of interest and relevance to trainees preparing for the membership examination of the Royal College of Psychiatrists: (a) advances in the genetics of bipolar affective disorder; and (b) mood-stabilising medication in bipolar affective disorder.

We report the rare occurrence of subarachnoid haemorrhage secondary to probable auto-enucleation of the orbit (oedipism) and we document management of these co-incident pathologies in a schizophrenic patient.

A 67 year old schizophrenic woman suffered a subarachnoid haemorrhage and presented with seizures following enucleation of her right eye. Initial efforts should focus on investigation and management of the subarachnoid haemorrhage. Management of Oedipism must include collaboration between psychiatrists, neurosurgeons and opthalmologists, focusing on management of the subarachnoid haemorrhage with precautions to prevent further self-injurious behaviour.

Suicidal behaviour is a major public health problem worldwide, both with regard to mortality and treatment of clients who have deliberately harmed themselves. It is a multifaceted problem resulting from complex interactions between social, biological and psychological factors. There is insufficient evidence on which to make firm recommendations about the most effective forms of treatment This is remarkable considering the extent of the problem worldwide, and the importance of dealing with it appropriately in order to prevent further suicides.

Early intervention in depression is important for many reasons including expeditious alleviation of suffering, assisting parenthood, suicide prevention and helping the economy. The fact that people with depression frequently employ maladaptive coping strategies, notably alcohol misuse, suggests the need for evidence-based self-help for sufferers. Self-help can be viewed as a philosophy of patient empowerment and as “a health technology solution to volume and demand”. Bibliotherapy (self-help using written materials) provides information and encourages the reader to make changes leading to improved self-management. Enthusiasm for the use of bibliotherapy in depression should be tempered by pursuit of a sound evidence base.

Objectives: An increasing number of research studies support the benefits of providing music therapy in addition to standard treatment for people who have mental disorders. The objective of this paper was to review and summarise recent research findings in relation to this work.

Method: A review of music therapy studies published since 1994 was undertaken. Criteria for including papers were that they a) were published in English in an indexed, peer-reviewed journal, and b) were conducted as a randomised controlled trial (RCT) or a controlled trial (CT), or c) provided a meta-analysis of existing studies. The large number of papers pertaining to music therapy for older adults who have mental disorders, including Alzheimer's disease and other types of dementia was not included.

Results: The findings support a role for music therapy as a structured interaction that patients are able to use to participate successfully, manage some of their symptoms, and express feelings relating to their experiences. Music therapy is demonstrated to be a beneficial intervention for people who have enduring mental illness. Music therapy invites and encourages participation from people of lower functioning levels and employs a non-verbal medium with which people have prior positive associations and in most cases have lifelong experience of using music for self-expression and pleasure. Additionally, the available peer reviewed literature supports the proposition that clinical outcomes are available through the use of music therapy intervention in conjunction with standard, well-established treatment methods.

Conclusions: Music therapy is beneficial for patients receiving care for mental disorders and establishing this therapy within mental health service provision should be considered.

We present a case of possible olanzapine-induced rhabdomyolysis in the absence of other features of neuroleptic malignant syndrome (NMS). There is evidence to suggest that there are different underlying pathophysiological mechanisms for rhabdomyolysis occurring alone, in contrast to when it presents as part of NMS. This has possible implications for drug rechallenge which is discussed.