Objectives: The changing family and social patterns in modern society are likely to influence the availability of informal support for older people. The aims of this study were to determine the support network distribution of a community dwelling elderly population in Dublin, and of those with mental disorders (dementia, depression and anxiety).

Methods: Interviews with 1,001 community dwelling older people using GMS-AGECAT. In addition, a support network assessment instrument was administered, which identifies five different support network types. The local integrated and wider community focused networks are characterised by extensive community involvement, family dependent networks by close family support, and the local self contained and private restricted networks by low levels of family and community involvement.

Results: Of the elderly population, 83% had support networks characterised by close community and/or family involvement. Subjects with cognitive impairment had lower levels of informal support from the community, as indicated by a lower proportion of local integrated (44% v 63%) and a higher proportion of private restricted (6% v 12%) networks. Late life depression was also associated with decreased levels of community integration.

Conclusions: The elderly in Dublin appear to have high levels of informal support. The extensive support may be a factor in the lower rates of depression found in Dublin than in London and New York. While the overall level of informal support available to older people with mental disorders in the community remains high, a proportion have low levels of family and community involvement and consequently their mental health problems may go unrecognised.

Objectives: To examine the underlying cognitive abilities of girls with Turner syndrome, as well as to examine the nature, direction and extent of discrepancies between verbal and performance functioning.

Method: Standard tests of intellectual functions (WISC-R and WAIS-R) were administered to 28 girls with Turner syndrome. Subjects varied in age between one year and nine years.

Results: The findings indicate that there is strong, though not entirely consistent, tendency among Turner subjects to show depressed performance scores in comparison with their verbal scores. There was also a tendency toward lower levels of overall cognitive functioning among girls with the classic karyotype over those with mosaic karyotypes.

Conclusions: These findings are in keeping with international findings concerning the intellectual functioning, of girls with Turner syndrome. The findings support the view that the X chromosome is important in regulating the overall balance within the intellectual functioning between verbal and performance domains.

Objectives: To investigate the development of dementia over a five year follow up period in a population of females with Down's syndrome; to examine age at onset and duration of dementia in the population; to document the clinical features of dementia and to highlight scores on functional and cognitive rating scales at diagnosis of dementia and at the onset of complete dependency.

Method: A five year follow-up study of 80 female subjects on prevalence of dementia, early clinical features of dementia and patterns of scoring on rating scales at diagnosis and end-stage dementia was completed. Results: Over the five year study period the number of subjects diagnosed with dementia rose from seven (8.75%) to 35 (43.75%). Age related prevalence figures showed that dementia was more common with increasing age. The earliest recognisable symptoms of dementia were memory loss, spatial disorientation and loss of independence especially in the area of personal hygiene. These findings were confirmed by the rating scales used in the study.

Conclusions: The earliest recognisable clinical features of dementia include memory loss and increased dependency. The results of this study should facilitate earlier diagnosis of dementia in DS.

Objectives: Despite their potential importance in affecting interactions between doctors and patients, there have been few attempts to measure attitudes to doctors and medicine. One scale, developed by Marteau, had shown a promising factor structure in a UK antenatal setting. The present study assessed its characteristics in Dublin general practice attenders.

Method: Patients aged over 16 waiting for a self-initiated consultation were recruited. The Attitudes to Doctors and Medicine Scale was administered by interview. Item analysis and factor analysis were used to examine its psychometric properties.

Results: Of 200 respondents, with a median age of 31, 144 were women. Item analysis showed lower reliabilities for the subscales of Marteau's scale than the original UK study, especially the subscales measuring negative attitudes to doctors and to medicine. Factor analysis failed to confirm a clear-cut distinction between attitudes to doctors and attitudes to medicine, and between positive and negative attitudes. Furthermore, factors which loaded in opposite directions in the original UK study loaded in the same direction in the Irish sample.

Conclusions: The differences found may reflect the differences either in culture or setting between the two studies. They strongly suggest that the Attitudes to Doctors and Medicine Scale does not have desirable psychometric properties. They also underline the need for a reliable and valid measure of attitudes to doctors and medicine, and for a more serious research interest in the area.

Objectives: This study examines the backgrounds of 100 people who died by suicide and whose cases were adjudicated on consecutively over a five-year period, by the two Cork City coroners.

Method: Five main sources of information were used; coroners, relatives, investigating police, general practitioners and hospital records. The cases were examined under the headings of age and gender differences; methods used; social circumstances; illness; treatment prior to death and previous attempts. Certain information may have been missed because peers were not interviewed. There were 72 males and 28 females.

Results: In the 15-44 age group, the male female ratio was 4:1; in those over 45 the ratio was almost equal. Men were more likely to be unmarried even when age differences were taken into account. All the women and all but seven of the men had a psychiatric diagnosis, but women were more than more likely to have received medical treatment in the year before their suicide than men (OR = 6.6). Thirty-seven had made at least one previous suicide attempt.

Conclusions: The study confirms that suicide, particularly for men is becoming more a young person's problem. Psychiatric illness is the single commonest association. Over a third of suicides had made a previous attempt. These findings point to the need to improve recognition of psychological distress and find effective methods to reduce parasuicide.

Objectives: To establish the prevalence of psychological problems in older adolescents.

Method: The Youth Self Report was completed by teenagers in a class group. Percentages scoring above clinical threshold were calculated. Gender differences and variances between school type were examined.

Results: Seven hundred and seventy-nine students participated in the study, 373 males and 406 females. Of the girls 23% reported problems in the clinical range on total problem score compared with 19% of boys. Significant gender differences were noted on total problem and internalising scores but not on externalising scores. The levels of psychological problems did not appear to be influenced by school type. Of the total group 6.4% reported thinking of suicide frequently (almost twice as many girls as boys) and this rose to 25% of girls who scored in the clinical range of total problem score and 15% of boys.

Conclusions: Twenty-one per cent of adolescents had problems in the clinical range. Girls reported more problems than boys. It was surprising to find that there was no gender difference in reported levels of externalising problems. The high expression of suicidal and thoughts of self-harm in those with externalising and internalising problems is of concern. This highlights the vulnerability of older adolescents as they tend to fall between the current child and adolescent services. Service provision for this population should be a priority in rural areas and on a national basis.

Objectives: To investigate the nature and pattern of teenage admissions (13-18yrs) to the 14 adult psychiatric units in Northern Ireland (NI) between 1989 and 1995.

Method: An analysis of routine hospital data, a review of case-notes at one hospital and in-depth interviews with young people previously admitted to adult inpatient care.

Results: Sixteen per cent of all under 25s admitted during the six-year period (443/2823) were under 18. There was an increasing trend over time in admissions and re-admissions to hospital. More than half of the teenagers were female and the most common diagnoses included emotional/conduct disorders, ‘stress’ and neurotic illnesses. Self-harm, substance abuse and exposure to violent/abusive environments or behaviour were the most commonly recorded factors preceding admission. All but one of the small number of people interviewed had attempted suicide prior to admission to hospital.

Conclusions: The increase in the use of adult inpatient care by young teenagers is of considerable concern but may be unavoidable in the absence of suitable alternatives especially for adolescents at risk of self-harm or suicide. Further research is required to determine the most appropriat e and effective service response for this vulnerable group . The findings have important implications for the future development of adolescent mental health services.

Objectives: Some patients with mental illness have said that religion (whether institutional or private) provides them with resources to cope with their illness. The aim of the study was to examine the spiritual well-being and religious practices, beliefs and psychological morbidity of psychiatric patients (n = 41) compared to control groups of patients with chronic medical conditions (n = 40) and community controls attending their GP (n = 39).

Method: The study was a cross sectional survey. The study group were identified in psychiatric rehabilitation and day unit settings, the medical controls from a physical rehabilitation hospital and rheumatology outpatient department and the community controls from a GPs surgery. General Health Questionnaire-28 (GHQ-28), the Spiritual Well-Being Scale (consisting of religious and existential well-being subscales) and an open-ended Religious Survey Questionnaire were personally administered to the groups and information supplemented by casenote data.

Results: Although there were no differences between the groups on the measure of overall Spiritual Weil-Being or on the subscale of Religious Well-Being, the psychiatric group scored lower on the Existential Well-Being subscale (p < 0.001) and had higher scores on the GHQ-28 (p < 0.001). The psychiatric group had increased frequency of private religious behaviour (p < 0.05) (praying and reading the Bible) which were thought to be coping strategies. Existential Well-Being of the whole sample was positively correlated to religious beliefs (feeling close to God (F = 6,337, p < 0.001); believing everything is according to God's plan (F = 2,709, p < 0.05) and having a mission in life (F = 3,563, p < 0.05)) and to religious practice (attending church) (F = 3,489, p < 0.05). Regression analysis of the whole sample showed that 49.5% of the variance in Existential Well-Being could be predicted by the severe depression subscale of the GHQ, but an additional 9.6% of the variance in Existential Well-Being could be predicted by religious beliefs.

Conclusions: The psychiatric group expressed lower life satisfaction and purpose, and were more likely to be single and unemployed. Religious belief does impact on life satisfaction and could be considered as an adjunct in the management of some psychiatric patients.

Objectives: The aim of this study was to determine the profile of attenders at psychiatric outpatient clinics in community health centres in Dublin.

Method: A chart review was undertaken retrospectively on attenders at two clinics in different socioeconomic areas. Demographic data and information on services was recorded. Psychiatric outpatient clinic functioning in a community setting was observed during the period of the study.

Results: The findings of this study suggest that attenders at psychiatric OPD clinics are more likely to be long-term, in the 40-50 year age group, female, unemployed and eligible for free medical care within the General Medical Services (GMS). Mood (affective) disorders was the largest diagnostic category. There were financial barriers to patient discharge to primary care and shared care with general practitioners.

Conclusions: Opportunitie s have been identified to improve communication and optimise patient flow through the psychiatric OPD system. Such improvements in clinic function would be likely to lead to enhanced health gain for attenders.

Objectives: The aim of this study was to undertake a satisfaction survey of users of psychiatric OPD clinics.

Method: Attenders were surveyed at two clinics A&B, situated in different socio-economic areas by using a self administered questionnaire. General practitioners who refer patients to these clinics were also surveyed.

Results: Patient satisfaction with psychiatric OPD clinics is high, (90%). Satisfaction is significantly affected by waiting times and receiving sufficient information on treatment. The local pharmacist would seem to be preferable to the majority of patients to dispense their medication. Patients attending Clinic A were critical of facilities in Clinic A Health Centre. The majority of general practitioners considered that their patients' needs were being met by OPD but would welcome more frequent communication. They were also in favour of shared care.

Conclusions: The establishment of Advisory/Advocacy Groups or user forum would provide a monitor for quality of service for psychiatric OPD clinics.

Objectives: This small exploratory study aims to investigate the characteristics of those convicted of rape or serious sexual assault against an elderly person (aged 65 years or over) who were referred to the Irish Forensic Psychiatry Service for assessment.

Method: A retrospective examination of the case histories of such individuals both at the Central Mental Hospital, Dundrum, Dublin and at Arbour Hill Prison, Dublin between 1989 and 1995.

Results: Ten such cases were found. The most frequent diagnoses were those of schizophrenia and alcohol dependence syndrome. A dual diagnosis of both schizophrenia and alcohol dependence was common. A high percentage of the schizophrenia cases had been previously charged with sexual offences and most were non-compliant with prescribed psychotropic medication at the time of the offence.

Conclusions: A very small number of people with mental illness may be at increased risk of committing a sexual offence against an elderly person. Further study of such offenders is merited.

Objectives: To audit the prescribing of clozapine for inpatients at a large, specialist psychiatric hospital.

Method: The clinical standards used were agreed by the authors after reference to the clozapine data sheet and British National Formulary (BNF). Prescribing practices for forty-six patients were audited.

Results: In this population of difficult to manage, treatment-resistant schizophrenic patients, prescribing and case note documentation needed improvement. Although almost all of these patients had had an adequate trial of clozapine monotherapy, over a quarter were currently receiving clozapine augmented with another antipsychotic. Plasma clozapine monitoring was used only once in a patient who had failed to respond adequately to clozapine.

Conclusions: Clinicians should fully document the patient's consent to treatment, the clinical response to treatment and the reasons for any deviation in clinical practice from that recommended by the data sheet and national formulary. Plasma clozapine monitoring should be used to optimise therapy and clinical rating scales should be used to evaluate outcome. Until the clinical effectiveness of clozapine augmentation strategies is proven, their use should be restricted to cases where evidence-based therapies have failed.