Objectives: This study examined the impact of psychiatric teaching on attitudes toward psychiatry of a cohort of medical students by means of a questionnaire survey. The impact of social desirability bias on questionnaire responses was also explored. Gender and nationality subgroups in the cohort were examined in more detail to determine whether these variables had any bearing on attitude change.

Methods: Fifth year medical students at NUI Galway completed the Attitudes to Psychiatry-30 questionnaire at the beginning and end of the psychiatric curriculum.

This was coupled to the Marlowe-Crowne Social Desirability Scale (13 items) to determine the effect of this potential bias on responses to the attitudinal scale.

Anonymity was ensured by using unique identification codes on the questionnaires, which facilitated individual comparisons of pre- and post-teaching responses.

Results: Attitudes toward psychiatry were positive prior to training but significantly improved following the teaching programme.

There was no difference in attitudinal change between male and female subgroups.

While students from outside the EU did show an improvement in mean scores on the ATP-30 this increase failed to reach significance. This finding was in contrast to the results for students from EU states whose mean increase on the ATP-30 was highly significant.

Social desirability questionnaire scores fell significantly between the first and second administration, lending support to the findings being a true reflection of the students' attitudes toward psychiatry.

Conclusions: These findings suggest that a teaching programme has the ability to influence students' attitudes. This is encouraging for recruitment into psychiatry and overall patient care.

Assertive Community Treatment (ACT) has developed globally as a model of community care for the severely mentally ill. However, in the United Kingdom there is mixed evidence regarding improvements in outcome and concerns about ACT teams having poor fidelity to the original ACT model.

Objective: This study presents the fidelity characteristics of an established ACT team serving Gloucester City. It describes service user demographic and illness data and compares these findings to other important studies in the United Kingdom.

Method: The Dartmouth Assertive Community Treatment Scale was applied to rate the Gloucester ACT team's fidelity characteristics. The Gloucester Caseload Project Demographic Pro-Forma was collected from all of the team's 79 service users.

Results: The population of severely mentally ill ACT service users in Gloucester City were an older and more “disabled” group compared to the classic ACT studies. Furthermore, although findings indicate a high level of fidelity to the original ACT model, the team it is still associated with high levels of inpatient treatment.

Conclusion: High fidelity ACT services appear to be associated with high admission rates. Therefore teams should not be viewed as alternatives to hospital admission but have goals of improving engagement and social functioning. Furthermore, findings have allowed the team to benchmark its service and target areas for further service development. More consistent reporting of fidelity data on ACT research would facilitate comparison across different services.

Objectives: The demand for places in supported accommodation is likely to rise due to the increasing longevity of people with intellectual disabilities and as their parents become unavailable or unable to care for them. However few attempts have been made to ascertain carer's views on alternative accommodation.

Method: Four studies were undertaken in Northern Ireland to ascertain carer's views using three different methods. In all, 387 carers participated with the response being greatest for individual interviews conducted in the family home and least for self-completed questionnaires and attendance at group meetings.

Results: The majority of carers envisaged the person continuing to be cared for within the family. The most commonly chosen out-of-home provision was in residential or nursing homes, living with support in a house of their own and in homes for small groups of people. Few carers chose living with another family. However only small numbers of carers envisaged alternative provision being needed in the next two years and few had made any plans for alternative living arrangements.

Conclusions: The implications for service planning are noted, primarily the need for individual reviews of future needs through person-centred planning; improved information to carers about various residential options and their differential benefits, along with more services aimed at improving the quality of life of people living with family carers. These need to be underpinned by a commitment of statutory agencies to partnership working with family carers. The implications for mental health services are noted.

Objectives: There has been no specific planning for older people with enduring or recurrent severe mental illness in Ireland. This survey aims to identify the number of affected over 65 year olds (graduates) and 55-64 year olds (prospective graduates) in the Health Service Executive, Eastern Region, their diagnoses and their use of psychiatric services.

Method: A comprehensive survey of the ten general adult psychiatry and four old age psychiatry services in the (HSE) Eastern Region was undertaken for the year 2003 to determine the number of patients, their diagnoses and service utilisation.

Results: 649 people over 65 years old were identified within the general adult psychiatry services and a further 279 within the old age psychiatry services giving a total of 928. (This number rose to 1141 after correcting for missing outpatient data.) 1,397 people between the ages of 55-64 were identified. (This number rose to 1,916 after correcting for missing outpatient data.)

Conclusions: There are substantial numbers of ‘graduates’ and ‘prospective graduates’ in the Eastern Region. It is essential that services for this population are specifically planned for and further qualitative research is required to inform this process.

Objectives: To review the literature on older people with enduring or recurrent severe mental illness with an onset earlier than 65 years (graduates) and, in particular, to look at the specific features and needs of this group.

Method: A Medline literature search produced 41 relevant papers and reports on the subject.

Results: There are a substantial number of older people with severe mental illness and the number will rise in line with increased longevity. As they age these patients' psychiatric disabilities are compounded by medical and social problems. The move to community based care has largely ignored the needs of graduates who were previously cared for in psychiatric institutions.

Conclusion: There is an urgent need to plan and develop adequate services for this vulnerable group.

We report on the case of a 15-year-old boy referred to Warrenstown inpatient unit for management of what appeared to be a typical case of anorexia nervosa. Over the course of his admission however, this diagnosis was no longer considered appropriate and substituted for a food avoidance emotional disorder. This is one of a number of cases of young males who have recently been referred for inpatient management of anorexia nervosa but which emerged into something quite atypical. The limited usefulness of the ICD-10/DSM-IV criteria in the diagnosis of an eating disorder in childhood and adolescence in this case reflects a broader level of discontent with the application of such diagnostic classification systems in a paediatric population.

We report the rare occurrence of subarachnoid haemorrhage secondary to probable auto-enucleation of the orbit (oedipism) and we document management of these co-incident pathologies in a schizophrenic patient.

A 67 year old schizophrenic woman suffered a subarachnoid haemorrhage and presented with seizures following enucleation of her right eye. Initial efforts should focus on investigation and management of the subarachnoid haemorrhage. Management of Oedipism must include collaboration between psychiatrists, neurosurgeons and opthalmologists, focusing on management of the subarachnoid haemorrhage with precautions to prevent further self-injurious behaviour.