Objectives: The prescription of stimulant medication to children with attention deficit hyperactivity disorder remains topical. Few reports target children's views about taking long-term medication. The aim was to assess child and parent views of stimulant medication. To compare attitudes to medication between two groups of children, those with attention deficit hyperactivity disorder taking stimulant medication and those with epilepsy taking anti-epileptic medication.

Method: Forty children (n = 40) with attention deficit hyperactivity disorder on stimulant medication, and 40 children (n = 40) with epilepsy on anti-epileptic medication formed the study population. A semi-structured interview was carried out with each child and parent. Each parent completed the Dosage and Side-effects Questionnaire and the Attitude to Medication Questionnaire. Each child completed the Attitude to Medication Questionnaire.

Results: Sixty per cent of children (n = 24) with attention deficit hyperactivity disorder and 62.5% (n = 25) of those with epilepsy knew the name and purpose of their medication. Forty per cent (n = 16) of children in the stimulant group and 32.5% (n = 13) in the anti-epileptic group reported themselves as being non-compliant with medication. In both groups children reported positive aspects to taking medication. More children with epilepsy reported negative aspects. Only 32.5% (n = 13) of children with attention deficit hyperactivity disorder said that they would tell a friend about their medication, while 55% (n = 22) of the children with epilepsy indicated that they would do so. In both groups parents were better informed than their children were about the purpose of the medication. Parents of children with attention deficit hyperactivity disorder tended to be more positive about medication than their children and than the parents in the comparison group.

Conclusions: The majority of children and their parents express positive views about the stimulant medication. Children's views about medication compliance and side-effects should be sought, as they may differ significantly from those of their parents. Where parents have noticed positive changes, but children have not, this information can be used therapeutically to help children feel more in control of their behaviour.

Objectives: To determine the extent of mental health services provided in the community in one Irish health board area. To examine the influence of postgraduate mental health training of GPs on provision of mental health services.

Method: Questionnaire and focus group methods were employed to determine views on mental health service provision. Data analysis was with parametric and non-parametric tests of association including student's t and chi-squared tests. Thematic analysis of the focus groups was carried out.

Results: Twenty-five per cent of patients attending general practice have mental health problems and over 95% of these problems are dealt with in primary care. Only 32% of GPs had received postgraduate training in psychological therapies. GPs with postgraduate training in psychological therapies were more likely to estimate a higher proportion of their patient population with mental health problems and less likely to refer to psychiatric services. A need for support from other health care professionals in primary care was also identified.

Conclusion: The majority of patients with mental health problems are treated in primary care. Further training of GPs and increased resources would improve mental health care in primary care and lead to fewer referrals to psychiatric services.

Objectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.

Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.

Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.

Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

Objectives: To describe the psychosocial and clinical characteristics of children referred to a community-based child and adolescent mental health service, whose mothers reported that they took opiates during the pregnancy.

Methods: In a retrospective study, the case notes of all children whose mothers reported that they had been exposed to opiates in utero, and who were referred to the Department of Child and Family Psychiatry, Mater Hospital, between 2001–2003, were identified by maternal reports. Information was obtained on age, gender, referral source, socio-economic group, family type, number of siblings, involvement of community care services, nature of presenting problems, diagnosis, interventions offered, and treatment difficulties. Information was recorded anonymously.

Results: 15 children were identified, of whom nine were male. Most were found to be living with their mother alone or with their mother and a partner, and to be socially and financially disadvantaged. Their presenting complaints usually involved combinations of aggressive, hyperactive, and oppositional behaviour. Diagnoses included ADHD, a speech and language disorder, and an axis II disorder. Interventions were frequently unsuccessful because of parents' difficulties with attending appointments, and because of instability in the families' living arrangements.

Conclusions: These children, due to a complex interplay of biological and psychosocial adversity, are at serious risk of ongoing psychiatric disorders in childhood and adolescence, and for adverse outcomes in adult life. A prospective cohort study of all children born to opiatedependent mothers is necessary to quantify the level of risk and identify resilience factors.

Objectives: To evaluate the relative contributions of peers cannabis use or non use, parental approval of such use, adolescents' own beliefs about use, self-esteem, and depressive and symptoms of borderline personality disorder, in the prediction of cannabis use and dependence.

Method: Participants were 257 high-school students who completed questionnaires assessing cannabis use frequency, cannabis dependence, the number of peers using cannabis, the number of peers opposed to cannabis use, parental attitude toward cannabis use, participants' attitude toward use, self-esteem, depressive and borderline symptomatology. Logistic regression analyses were conducted to predict cannabis use, daily use and dependence.

Results: The number of peers using cannabis, participants' approval of cannabis use, and the intensity of symptoms of borderline personality disorder were risk factors for use whereas the number of peers opposed to cannabis use was a protective factor. Parental attitudes toward use and participants' depressive symptomatology were not significant independent predictors of use. There were no significant predictors of probable cannabis dependence.

Conclusion: To inform adolescents that a significant proportion of them disapprove of cannabis use may be an effective component of prevention of use. Symptoms of borderline personality disorder may account for the association between depression and cannabis use. The social influences and psychopathological factors evaluated in this study did not appear to play a major role in the development of cannabis dependence.

Objectives: People with intellectual disabilities are increasingly living in more domestic style accommodation, either in housing provided within a specialised campus setting or in ordinary houses in community settings. The main objective of the study was to determine if the extent of residents' involvement with their families and with the local community varied when they resided in campus settings (n = 55) or community housing (n = 51) and to investigate the main predictors of this involvement.

Method: With the resident's permission, their key-workers – mainly nurses – completed standard questionnaires that covered resident characteristics, contact with families and a range of life experiences.

Results: Although the type of accommodation did have a significant effect on residents' social inclusion in families and communities, the best predictor of this was the individual's level of dependency in personal self-care. Those who were more dependent tended to be more excluded.

Conclusions: Staff working with more dependent residents need to proactively promote their social inclusion although this could be harder to achieve for those living in campus style settings.

Objectives: To ascertain the relationship between social network type and depression over time.

Method: A longitudinal outcome study of depressed elderly patients attending an old age psychiatric service was carried out. Subjects were seen at baseline and regular intervals over two years.

Results: Depression severity at baseline and at follow-up times differed according to subjects' social network. Those with more socially integrated networks had the best outcome and those who had more dependent networks had a poorer outcome. There was a lot of movement between networks over time for subjects, with many moving towards more dependent networks.

Conclusions: When treating depression in the elderly it is important to consider the social network and milieu in which the patient resides. Treatments should include strategies encouraging the maintenance and formation of social integration.

Objectives: The study reports on benzodiazepine use among opiate dependent patients attending National Health Service community prescribing services and examines current practice in the clinical management of benzodiazepine dependence.

Method: A postal questionnaire survey of 174 NHS substance misuse services in England and Wales.

Results: A 71% response rate was achieved. Services estimated the prevalence of benzodiazepine use to be 40% and the prevalence of benzodiazepine dependence to be less than 25% among opiate dependent patients in treatment. Illicit supplies (street) and general practitioners were regarded as the most common source of benzodiazepines. The most commonly reported reasons for benzodiazepine use were for the direct intoxicating effects and for the treatment of anxiety/insomnia. The majority of services (93,75%) reported prescribing benzodiazepines to patients for benzodiazepine detoxification while 43 (35%) reported prescribing for benzodiazepine maintenance treatment. The variations in benzodiazepine prescribing practices across services are described.

Conclusions: Benzodiazepine use remains common among opiate addicts in contact with treatment services. The majority of services surveyed reported prescribing benzodiazepines but there was much variation in clinical practice nationally. There is need for further research to identify effective treatment approaches for comorbid benzodiazepine dependence in opiate misusers.

Objective: The aim was to observe whether medical inpatients screening positive for depression using the Geriatric Depression Scale (GDS) continue to screen positive following hospital discharge.

Method: Participants aged 65 or over, were recruited from consecutive admissions to a city teaching hospital. Subjects had an Abbreviated Mental Test Score (AMTS) of seven or above and a GDS-15 score of five or above. Information was collected on past psychiatric history and living arrangements. Subjects were followed-up three months later and the GDS repeated.

Results: Thirty subjects were recruited and 26 (87%) followed-up. Ten (38%) no longer scored positive on the GDS, and overall the mean GDS score decreased by two points (Z = 2.235 p < 0.05). Patients with a past psychiatric history or living alone were more likely to be depressed at follow-up. No participants were referred to the psychiatric service or started on antidepressant medication during the course of the study.

Conclusion: Depressive symptoms are likely to persist following hospital discharge, especially in those patients with a past psychiatric history. An understanding of the risk factors associated with persistent depressive symptoms is necessary if the patients appropriate for treatment are to be identified.

Objectives: To estimate the psychiatric service requirements for the remand population.

Method: We interviewed 232 (42.6%) men, a representative sample of men on remand, using the SADS-L, SODQ and a structured demographic interview.

Results: We found high rates of psychiatric morbidity in our sample. The six month prevalence of psychosis was 7.6%, almost twice the rate in a recent international meta-analysis. Major depressive disorder was present in 10.1% (six month prevalence). Substance misuse problems were also common but there was no significant difference between rates of substance misuse in psychotic and nonpsychotic prisoners. A total of 31.2% had a lifetime history of any mental illness (excluding substance misuse, adjustment disorder and personality disorder).

Conclusions: The high levels of psychiatric morbidity detected in our sample indicate a substantial unmet need for mental health services and addiction treatment services for the mentally ill in Irish prisons.

Objectives: Following disruption from students, particularly boys, during the administration of item 10, the ‘feel like crying’ question, of the Children's Depression Inventory (CDI), this study sought to explore the issue of non-response to this question. It was decided that particular attention should be given to gender differences in responses and non-responses, based on the experiences of researchers administering this measure.

Method: Chi-square analysis of non-responses was conducted on CDI items collected from a total sample of 2,297 second year and pre-leaving certificate students from 23 randomly selected schools in the Mid-West region of Ireland.

Results: Analysis identified item 10 as being significantly less likely to be completed than any other item. Further analysis revealed that boys were significantly less likely to respond to this question than girls.

Conclusion: A modification of the wording to item 10 is suggested to ameliorate this difficulty.

Objectives: As part of an outcome study of depression in older people, the relationship between physical disability and depression was explored at baseline and longitudinally. The aims were to identify whether illness in specific body systems or physical disability was associated with a poorer outcome of depression.

Method: Subjects over 65 with depression referred to an old age psychiatry service were recruited. Depression was diagnosed according to ICD-10 criteria. An in-depth initial assessment obtained data concerning depression severity and illness in specific body systems as well as disability levels. Objective and subjective ratings of health status were also made. Subjects were followed up at three, six, 12, 18, and 24 months. Ongoing assessments were made of depressive symptomatology and of physical status.

Results: Subjects with higher disability levels had more severe depression at baseline. There was no relationship between illness in specific body systems and depression severity. At follow up assessments, those with higher disability scores had poorer outcomes as recorded by depression rating scales and by reviewing the longitudinal course of depression in terms of proportions remaining well, suffering relapses or remaining depressed.

Conclusions: There is an ongoing relationship between depression and disability. Older people with greater physical disability have a poorer outcome of depression. Service providers should be aware of this relationship and respond rapidly and assertively to depression in older people with disability. There should be a lower threshold for initiating treatment in this population.

Objectives: We sought to determine the frequency of learning disability (IQ > 70) among referrals over a period of six years to a community child psychiatric service in a socially disadvantaged area of Dublin.

Methods: We investigated the gender and age characteristics, as well as the frequency of speech and language, emotional, and behavioural problems in this group. We tried to determine what educational help each child was receiving at the time of referral.

Results: Sixty-five of 942 patients referred to the clinic had a mild (60) or moderate (five) learning disability. Forty-eight patients were male and 17 were female. The mean age at referral was 10.5 years, and there was no gender difference. All were referred because of educational problems. Behavioural disorders were present in 31, emotional disorders in 13 and speech and language disorders in 37. Six had suffered some form of abuse, mostly emotional. Five had problems with concentration or markedly impulsive behaviour. At the time of referral, 10 were in special schools, seven were in special classes in normal schools, and nine had a special resource teacher. Adequate educational support was not being adequately provided for 33 at the time of psychiatric referral.

Conclusions: Learning disability occurs in 7% of children referred to the child psychiatry clinic of a disadvantaged urban community and, while this may reflect the late onset of psycho-social and educational problems in such children, these findings give cause for concern that delayed referral may exacerbate their and their families' problems. The educational needs of most of the children were not being addressed. Reasons for these findings are discussed.