Suicide is a major public health issue of global concern. It is the leading cause of death in young Irish men, marking suicide and suicidal behaviour as important topics for clinical epidemiology and public health research. Ireland has a statutory obligation from the “Reach Out” policy document to “systematically plan research into suicidal behaviour to address deficits in our knowledge” (pp. 50). Suicide is undoubtedly a complex phenomenon and therefore one which requires advanced methods of investigation and innovative approaches to research the factors underpinning suicide in modern Ireland, the development and evaluation of prevention strategies and the informing of evidence-based policy.

Objectives: Structured professional judgement is now the most widely accepted approach to clinical risk assessment and risk management. The Suicide Risk Assessment and Management Manual (S-RAMM) is a new structured professional judgement tool closely modelled on the HCR-20. This is the first prospective validation study for this instrument.

Methods: Two post-membership registrars jointly interviewed 81 of 83 current inpatients to rate the S-RAMM. Two assistant psychologists independently rated the HCR-20, GAF and PANSS. All incidents of self-harm, attempted suicide, suicide and violence to others were collated from hospital reporting of critical incidents over the next six months supplemented by examination of other records.

Results: For combined self-harm and suicide outcomes, the S-RAMM total score using the receiver operating characteristic had an area under the curve AUC=0.89, (95% CI 0.79 to 0.99). The S-RAMM performed as well for the prediction of self-harm and suicide as the HCR-20 did for violence, and better than measures of mental state (PANSS total score) and global function (GAF).

Conclusions: The S-RAMM has better than minimum acceptable characteristics for use as a clinical or research tool for suicide risk assessment, and performs almost as well as the HCR-20 does for violence. Further prospective studies are now required, in other populations.

Objectives: Deliberate self-harm (DSH) is the strongest predictor of suicidal behaviour. This retrospective study reviewed all DSH presentations to our Paediatric Emergency Department between 2002-2006.

Method: Using database and medical records we profiled these presentations. Data was coded and statistically analysed.

Results: There were 253 DSH attendances. Twenty-four percent were living in care, 15% were under 12 years and 14% presented more than once. Overdoses (61%) were more common than cutting (16%) and 56% had a psychiatric condition.

Conclusions: DSH presents an ongoing challenge to child and adolescent mental health services and those working in suicide prevention. Identifying the characteristics of these young people is essential to providing appropriate treatment for this high-risk group.

Objectives: There is a substantial knowledge gap about the distribution of mental health in community populations. The European Social Survey is particularly useful as it contains information on over 40,000 individuals, including 2,286 Irish adults. The objective of this study is to conduct a large scale statistical analysis to examine the distribution and determinants of mental wellbeing in a large representative sample of the Irish population.

Method: Analysis of the European Social Survey using robust multiple linear and non-linear regression techniques. The data-set contains WHO-Five scores and subjective wellbeing for a sample of 2,286 Irish people interviewed in their homes in 2005.

Results: Ireland has the second highest average WHO-Five score among the 22 countries in the European Social Survey. Multiple linear regression analysis across the distribution of WHO-Five reveals a wellbeing gradient largely related to education and social capital variables. A probit model examining the determinants of vulnerability to psychiatric morbidity reveals that a similar set of factors predict scores below the threshold point on the WHO-Five scale.

Conclusions: The results are consistent with marked differences in mental wellbeing across education levels and variables relating to social capital factors. Such indicators provide a useful index for policy-makers and researchers. However, much further work is needed to identify causal mechanisms generating observed differences in mental health across different socioeconomic groups.

Objectives: To assess patient satisfaction with mental health services. Client satisfaction with mental health services is attracting increasing attention and is now considered a key outcome variable in evaluating mental health services. The Quality Framework (Mental Health Commission (MHC)), and Vision for Change (VFC) support such evaluation. However, there are no published quantitative data from Irish users of a community mental health service.

Method: We invited outpatients attending a Dublin community mental health service to complete a standardised self-report instrument (Client Satisfaction Questionnaire, CSQ-8) and provide qualitative feedback.

Results: Of the seventy-nine respondents, 80% report they were ‘satisfied’ or ‘very satisfied’ with the service. However, they were critical of; access to, operation of, and communication with the mental health services.

Conclusions: Although satisfied, when given the opportunity to comment, service users can be critical of aspects of the service they receive. Only using quantitative evaluation of outpatient client satisfaction levels may fail to capture important consumer suggestions for service development. Recent recommendations and upcoming changes would address a number of the criticisms of mental health services identified in this study.

Objectives: This study aims to investigate the prevalence of neuropsychological disorders in a non-specialist clinical psychology service in adult mental health service and also to explore the existence of neuropsychological symptoms in those subjects having psychiatric disorders.

Method: The yearly data of new referrals from the psychology register and record files of the patients was collected for this purpose and subsequently analysed. The two content scales of MMPI-2, ie. HEA2 and HEA3 were administered and scored.

Results: The results indicate that neuropsychological disorders were the second major referral source during this period and a significant difference (p = 0.001) was found between the scores of HEA-2 and HEA-3, which suggest that the subjects reported more neuropsychological symptoms than symptoms of general health concern during their initial routine psychological assessment.

Conclusion: There is consistency in our findings regarding the questions raised in this study which indicates a prevalence of neuropsychological disorders in adult mental health settings. It also indicates a high rate of neurological symptoms in psychiatric patients with psychiatric disorders.

Objectives: The most recent census of psychiatric inpatients (Daly and Walsh, 2006) examined the decline of the long-stay population (both new and old long-stay) from 1963 to 2006. The aim of the present study was to identify new long-stay patients (patients in hospital between one and five years) in the 2006 psychiatric in-patient census and follow them up one year later to determine the number remaining as inpatients, ie. not having been discharged

Methods: New long-stay patients were extracted from the 2006 psychiatric inpatient census data base and were followed up one year later.

Results: Sixty-eight per cent (315/460) of new longstay patients on 31/03/06 were still resident in units and hospitals one year later on 31/03/07, the majority in psychiatric hospitals Forty-two per cent (133/315) of patients had a primary diagnosis of schizophrenia, 13% (40/315) of depressive disorder, 11% (33/315) of organic mental disorder and 8% of intellectual disability (24/315). The number of new long-stay patients discharged or who died showed a sharp decline on previous years.

Conclusions: Unless current services are improved and extended as advocated in A Vision for Change, it will be a number of years before this population leaves psychiatric hospitals and such hospitals can close because of the lack of suitable alternatives. In accordance with policy recommendations, the continuing requirement for the development of specialised rehabilitation services to cater for the broad needs of those who remain in psychiatric hospitals is of the utmost importance.

Objectives: Features of gambling, particularly among young people have changed over the past decade and, while there are no data from Ireland, there are suggestions from those working in the field that pathological gambling is increasing among adolescents. Relatively little is known about the effective treatment of pathological gambling in adolescents. This paper aims to review research in cognitive behavioural treatments with a view to their application in adolescents. Research among adolescence is given prominence when this is available.

Methods: The methodology comprised a literature search of Medline, Psycinfo, and EMBASE databases, using the search terms: ‘cognitive behavioural therapy’; ‘gambling; ‘psychology’; ‘epidemiology’; ‘adolescent’; ‘motivation’; ‘effectiveness’; ‘outcome’; ‘relapse’; and ‘internet’. In addition, a hand search of Clinical Psychological Reviews, Journal of Gambling Studies, Addiction, Psychology of Addictive Behaviors, and International Gambling Studies (1997-2007) was performed.

Results: A total of 23 studies comprising various cognitive and behavioural approaches were identified, all but three of them confined to adult subjects. Study methodology and quality varied greatly, with many case studies or small case series, and only three randomised control trials. None used an intention-to-treat analysis, and there was little long-term follow-up. Almost ail indicated, with more or less evidence, that cognitive behavioural strategies might be beneficial.

Conclusions: Many varieties and modifications of cognitive behavioural therapy have been applied to pathological gambling, though there are few studies of any psychological treatments for adolescent gamblers. Methodological problems surround much of the research. Notwithstanding these reservations cognitive behavioural approaches seem to offer promise in managing this serious problem.

Clozapine, the drug of choice for treatment resistant schizophrenia, has a range of serious cardiac side-effects. This paper describes a fatal case of myocarditis in a 48 year old man four weeks after starting clozapine. In particular, this case illustrates how incipient the disorder can be and the need for a high level of suspicion. Difficulties in diagnosing clozapine induced myocarditis and ways to minimise its risk are also discussed.

Clozapine is an atypical antipsychotic indicated for paranoid schizophrenia (treatment resistant type). However its use has been limited by the well established association with neutropenia and agranulocytosis. It has also been suggested that clozapine therapy is associated with other serious adverse effects such as fatal myocarditis or cardiomyopathy.