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: 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: To evaluate the clinical utility and validity of the Health of the Nation Outcome Scales (HoNOS) in an Irish catchment area psychiatric service.

Method: One hundred consecutive outpatients were assessed using the HoNO S and Global Assessment of Functioning (GAF) scales.

Results: It was feasible to administer HoNOS in day-to-day clinical practice. There was a statistically significant correlation between the HoNO S and GAF scores. Attenders at the outpatient department had significantly lower HoNOS scores compared to individuals assessed on domiciliary visits or at the day hospital. Individuals with schizophrenia had significantly higher HoNO S scores compared to affective disordered patients. However, this difference was confined to the Social subscale of HoNOS.

Conclusions: Although these findings indicate that HoNOS has significant convergent and criterion validity as a measure of psychiatric morbidity, its widespread use in day-to-day clinical practice may be premature.

Objectives: Nalbuphine (Nubain) is a synthetic opioid analgesic with agonist-antagonist properties. This study describes a characteristic patient profile, pattern of use and treatment outcome for a series of nalbuphine dependent subjects.

Method: Retrospective systematic case-note review of uniformly collected clinical data on 11 cases of nalbuphine dependence presenting to a substance misuse service.

Results: There were nine males and two females with a mean age of 31 years of whom nine were currently employed. At presentation the mean duration of nalbuphine use was three years, the average daily dosage was 60mg (range lOmg-lOOmg) and all subjects reported injecting between two and eight times daily (mean five times daily). All subjects met opioid dependence criteria (ICD-10). Drug-related problems were multiple and varied while forensic history was uncommon. Exposure to nalbuphine occurred exclusively within the gymnasium environment and was used by bodybuilders to enhance weight training and bodybuilding. Eight subjects admitted previous anabolic steroid use, and seven current cocaine use. Eleven subjects represented 14 separate treatment episodes of which 11 treatment episodes involved the use of methadone substitution therapy. The mean stabilisation dose of methadone was 29mg (range 15mg-40mg) and in eight episodes (73%) patients were successfully retained in treatment to completion of detoxification.

Conclusions: Dependence on nalbuphine, an agonist-antagonist opioid previously believed to have low abuse potential, does occur and may be particularly associated with bodybuilders who use its analgesic properties to facilitate pain free training. Its use appears linked not only with other performance enhancing drugs (viz. anabolic steroids) but may also be associated with other psychoactive drugs such as cocaine. Methadone substitution therapy appears to be a viable treatment option.

Objectives: To evaluate the self-rated or subjective quality of life of individuals with schizophrenia in residential care settings.

Method: Forty individuals who fulfilled DSM-IV criteria for schizophrenia were interviewed using the Lancashire Quality of Life Profile.

Results: Fifty-two per cent of the sample reported their global subjective quality of life to be satisfactory. Global subjective quality of life was rated lower than the majority of life domains evaluated. The areas of least satisfaction included finances and work. However, the majority of patients were satisfied with their living situation, safety, health, religion, leisure, social and family relations. There was some evidence of a quality of life gradient across these residential settings.

Conclusions: Although these patients were satisfied with the majority of life domains assessed, these data need to be interpreted cautiously given the limitations of the study design and the method used to evaluate quality of life.

Objectives: The aims of this study were to identify the social and clinical needs of patients attending an inner city psychiatric service, to examine the relationship between need and various demographic and social parameters, and to demonstrate the usefulness of the Camberwell Assessment of Need (CAN) in an Irish population.

Methods: A random sample of patients was selected from a census of patients attending the Mater Hospital (Dublin) sector psychiatric service on March 1, 1997 for inclusion in the study. Needs were assessed using the Camberwell Assessment of Need.

Results: Fifty-seven patients agreed to participate in the study. The mean number of needs identified by patients was 2.14 (+/− 2.09) and by staff 1.92 (+/−1.18). There was a high level of correlation between staff and patients. The areas where patients most frequently expressed a need were ‘psychological distress’, ‘company’, ‘physical health’, ‘information’ and ‘looking after the home’. Eighteen patients (32%) identified needs that were not being met.

Conclusions: This study confirms the usefulness of the Camberwell Assessment of Need in the identification of clinical and social needs in psychiatric populations and demonstrates its usefulness in an Irish population.

Objectives: The aim of this study was to examine the prevalence of, and factors associated with violence in a drug treatment centre.

Method: This study is a retrospective audit of all incident forms completed at an urban drug treatment centre between December 1991 and July 1996 with reference to case notes for additional clinical information on individuals involved in violent incidents.

Participants included all patients attending the centre in the aforementioned time period who were involved in violent incidents. Information was obtained about the prevalence and severity of violent incidents and patient details including main drug of abuse, route of use, reason for attendance, comorbid axis 1 diagnosis, history of previous incidents and HIV status at the time of the incident.

Results: One per cent of all patients were involved in violent incidents. Less than one quarter of incidents involved serious injury or assault. Most perpetrators were male intravenous heroin users on a methadone maintenance programme. Nurses and doctors were most frequently the victims of incidents. Ten per cent of patients had a history of previous incidents and almost half the perpetrators were HIV positive. A comorbid axis 1 diagnosis was found in 9% of perpetrators (n = 6), mainly alcohol dependence syndrome.