Objectives: To examine eating concerns in a cohort of Irish adolescents.

Methods: Students from a stratified random sample of post primary schools were screened using the EAT-26, the EDI-III and a study specific questionnaire.

Results: A total of 3,031 students (mean age 14.74, range 12–19) enrolled in the study. The majority of respondents felt popular (91%), happy (75.2%) and perceived themselves to have a good quality of life (86.8%). Despite this, 32% of females dieted, 29.4% were dissatisfied with their bodies, and 10.8% scored above 20 on the EAT-26. Adolescents always on a diet reported a lower quality of life (QoL) X2(16, N=2,961) =144.43, p <.000, perceived themselves to be less popular X2(15, N=2,963) =53.26, p <.000 and less academically able X2(16, N=2,297) =43.96, p<.000, than those who never dieted. Comparing EPICA values to published norms, Irish males had significantly lower EAT scores, females had comparable total EAT-26 scores but significantly lower levels of dieting and higher levels of bulimic features and oral control. Girls in mixed schools had higher rates of body dissatisfaction F (1,2855) = 16.61, p <.001 and drive for thinness F (1,2860) = 11.78, p <.005 than girls attending same sex schools.

Conclusions: Weight and body image concerns were high among Irish adolescents, especially females, with higher than expected levels of bulimia and oral control scores on the EAT but lower scores on the dieting subscale. Females attending mixed sex schools appear most at risk of eating pathology.

Objectives: The aim of this study was to investigate the effects of topiramate (TPM) on cognitive function, specifically language, in patients with epilepsy, and to determine whether a specifically designed neuropsychological test battery can show such effects.

Method: Twenty patients taking TPM, 25 epilepsy controls (taking medication other than TPM) and 25 healthy controls were recruited. We used a specific neuropsychological battery, including measures of visual and verbal memory, attention, fluency and comprehension. Separate one way between group ANOVAs were performed for each neuropsychological measure.

Results: Bonferroni comparisons revealed that the TPM group performed significantly worse than epilepsy controls on digits forward (p<0.001), digits backward (p<0.05), controlled oral word association (COWA) (p<0.05) and token test (p<0.05). The TPM group also needed more multiple choice cues in the Boston naming test (p<0.05).

Conclusions: The present study indicates that 15% of the sample tested had impaired language abilities and raises interesting questions regarding the nature of this effect. Furthermore, we have identified some short neuropsychological tasks that can be performed in routine clinical situations that can reliably identify patients who have negative linguistic effects of TPM.

Objective: To examine the frequency of use of seclusion and the factors associated with its use in Lakeview Unit, a 29-bedded acute psychiatric unit in Naas General Hospital.

Methods: A survey was carried out involving a retrospective chart review of all patients secluded over a 12-month period, as well as a review of the seclusion register for this period. Secluded and non-secluded patients were compared for gender, nationality, age, diagnosis, duration of admission and admission status by reviewing discharge summaries of all patients admitted during the 12-month period.

Results: Most (75%) of the secluded patients were secluded only once. Half of seclusion events were initiated in the first week of admission. Length of time spent in seclusion ranged from 50 minutes to 96 hours, with a mean duration of 25 hours 20 minutes. Seclusion was most often associated with risk to others and risk to self. Alternatives to seclusion considered included verbal de-escalation, medication, special nursing, single room accommodation and time out Male and non-Irish patients were more likely to be secluded. There was no significant difference between secluded and non-secluded patients in terms of age. Patients with psychotic disorders tended to be secluded more frequently than others, followed by patients with bipolar affective disorder and substance use disorders. Longer duration of admission and involuntary admission status were strongly associated with seclusion.

Conclusion: Seclusion remains an important part of psychiatric practice on Lakeview Unit, and reflects indirect measures of illness severity. In order to reduce the duration of seclusion episodes, the development of alternative containment strategies needs to be addressed. Seclusion audits should be carried out regularly to ensure that best practice is adhered to.

Objectives: Over the counter (OTC) medication abuse is an increasing public health concern. We studied the clinical profiles, treatment and prevalence of patients admitted with OTC opiate abuse.

Method: Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded.

Results: Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.0 mg per person. Some 75% percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have co-morbid psychiatric (n=19, 95%), physical (n=17,85%) and polysubstance (n=13,65%) illness.

Conclusions: OTC opiate abuse is a significant problem which is largely covert in nature with serious co-morbidity and frequent complications including withdrawal symptoms which require treatment. Results of this study suggest that further research is warranted in this area.

Objectives: To examine why five patients with borderline personality disorder were contributing to a high bed occupancy and high staff turnover on a general adult psychiatry inpatient unit.

Method: A retrospective audit looking at these individuals' service pattern use for the two-year period between 2001–2003 was undertaken. A new admission policy was then introduced. The policy was that admissions were agreed, where possible, at consultant level and, if deemed unavoidable, were time limited. The audit cycle was repeated for the next two year period, 2003–2005 and a third audit cycle was then performed for the period 2005–2007.

Results: Following the new admission policy, there was a 95% reduction in bed days for this group. Untoward incidents by these individuals reduced by 93% and attendance at Accident and Emergency was also significantly reduced.

Conclusions: By limiting the frequency and length of admissions there was, unsurprisingly, a reduction in adverse incidents which lead to significant problems for patients and staff alike.

Objectives: We sought to determine the point prevalence of adult attention deficit/hyperactivity disorder (ADHD) in an out-patient psychiatric population.

Methods: Patients (n=243) attending five different outpatient clinics in a largely urban adult psychiatric service completed the Adult ADHD Self-Report Scale, a recently developed instrument by the World Health Organisation. Clinical and demographic data were recorded.

Results: There was a high apparent rate of adult ADHD detected (23.9%). Such patients were significantly more likely to have lower educational attainment, ADHD as children, a forensic history and the diagnosis of personality disorder as well as a higher rate of benzodiazepine use. They were no more likely to be dissatisfied with the service, nor to be heavier users of the service.

Conclusions: We report a high apparent rate of adult ADHD. Correlates of this high rate indicate individuals with less positive lifestyles than other patients. Screening for this disorder appears warranted, particularly in the light of the emergence of new non-amphetamine-based therapies.

Recent epidemiological trends in Irish suicide rates were examined and found to be consistent with worldwide trends. However, the time-series Irish suicide rate was not consistent with predictions made from Durkheim's classic theory of suicide. Finally, current theories of the etiology of suicide were used to derive a linear regression equation to predict the Irish suicide rate which turned out to be quite inaccurate.

The task addressed in this article is a review of the epidemiology of suicide in Ireland and, in doing so, the suicide rate in Ireland will be compared with the suicide rates of other nations of the world. Table 1 reports the suicide rate in Ireland from 1901 to 1949, Table 2 for the period 1950–2001, overall and for men and women (and parallel data for Northern Ireland are shown in Table 3). These data were compiled from Lester and Yang and from World Health Organisation publications and online (www.who.int). It should be noted that suicide was decriminalised in Ireland in 1993.

Catatonia is a neuro-psychiatric disorder that can occur in medical, psychiatric and drug-induced conditions but is often unrecognised. A 64 year-old woman was admitted to hospital for assessment of a significant deterioration in her ability to communicate and function normally so that she had become completely dependent on others for all activities of daily living for nearly three years. Outpatient medical and psychiatric assessments failed to clarify diagnosis. On admission to a general hospital, the neurology team initially believed she had a Parkinson's-like syndrome but after further investigation and comprehensive multidisciplinary assessment, including neuro-psychiatric review, she was diagnosed with catatonia. She was subsequently admitted to a psychiatric hospital where she received electro-convulsive therapy and changes to her psychotropic medication regimen. She responded well to treatment and within a short period of time was able to function independently again.

This paper examines the concept of early intervention in psychosis at primary and secondary prevention levels. Examples of early intervention service models from different countries are presented and we discuss current evidence for efficacy. We highlight the Irish experience of early intervention to date, and discuss future implementation of early intervention services in Ireland.

A 31 year-old man with a history of a depressive episode presented with acute severe ‘thunderclap’ headache. Magnetic resonance imaging (MRI) revealed abnormalities typical of cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), which was subsequently confirmed by genetic analysis. The psychiatric features of this genetic cause of depression and headache are discussed.

Antipsychotic medications are associated with adverse cutaneous reactions (ACRs) in approximately 2–3% of patients. We present three cases of possible risperidone induced periorbital oedema in the absence of any other systemic or local cause responsible for the oedema. The development of periorbital oedema after the initiation of risperidone therapy, and disappearance after the discontinuation of this drug, suggests a possible causal relationship between periorbital oedema and risperidone. To our knowledge, there are very few reports of risperidone therapy and development of periorbital oedema. Risperidone is a valid and effective choice amongst antipsychotic medications, but these cases call for caution regarding ACRs at the time of prescribing.

The impact of prenatal alcohol exposure is far reaching and transgenerational but is largely under diagnosed. This has been a major public health concern but remains an area that has lacked attention with regards service development and research in Ireland. There is a need for mental health professionals to have a good working knowledge of the range of deficits associated with prenatal alcohol exposure. Knowledge of these deficits will facilitate identification of affected children for early diagnosis and intervention. This paper reviews available literature on this topic using broad search criteria. The aim of this article is to create greater awareness among professionals working with children in Ireland considering the high rates of alcohol consumption and the fact that most cases of FASD present with chronic undiagnosed mental health problems.