With prevention and treatment of mental disorders a challenge for primary care and increasing capability of electronic medical records (EMRs) to facilitate research in practice, we aim to determine the prevalence and treatment of mental disorders by using routinely collected clinical data contained in EMRs.

We reviewed EMRs of patients randomly sampled from seven general practices, by piloting a study instrument and extracting data on mental disorders and their treatment.

Data were collected on 690 patients (age range 18–95, 52% male, 52% GMS-eligible). A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.

Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.

To report new prescriptions of psychotropic medications among adolescents presenting with new onset psychotic symptoms during a 5-year period.

The Northern Ireland Early Onset Psychosis Study is a naturalistic longitudinal observational study of patients with an early onset first psychotic episode. All patients aged <18 years presenting to specialist mental health services across Northern Ireland with new onset psychotic symptoms between 2001 and 2006 were recruited (n=113). Clinical case notes were analysed retrospectively for details of subsequent treatment with psychotropic medications.

A total of 100 patients (88.5%) were prescribed some form of psychotropic medication. Over three-quarters of patients received an antipsychotic as their first medication. Risperidone (45.8%), olanzapine (24.0%) and chlorpromazine (12.5%) were the most commonly prescribed first-line antipsychotic medications. Of a total of 160 antipsychotic prescriptions, 81 (50.6%) were off-label. Prescriptions were most likely to have been deemed off-label owing to medications not being licensed in under-18s (71.6% of off-label prescriptions) but other reasons were medications being used outside licensed age ranges (23.5%) and outside licensed indications (4.9%).

This is the first study examining psychotropic prescribing patterns in a complete sample of all children and adolescents presenting with early onset psychotic episodes in a single geographical area. The observation of risperidone as the most commonly prescribed antipsychotic was in keeping with previous studies in child and adolescent populations. Rates of off-label prescribing were lower than previously observed although our study was the first to investigate off-label prescribing solely in children and adolescents presenting with psychotic symptoms.

This study examines aspects of healthcare professionals’ knowledge and attitudes about eating disorders (EDs), which might impede the effective detection or treatment of EDs in Ireland.

A total of 1,916 healthcare professionals were invited to participate in a web-based survey. Participants were randomly allocated to view one of five vignettes depicting a young person with symptoms consistent with anorexia nervosa, bulimia nervosa, binge-eating disorder, depression or type 1 diabetes. Study-specific questions examined participants’ responses to the vignettes and ED knowledge and experience.

In total, 171 clinicians responded (9% response rate). Participants had an average of 15.8 years of clinical experience (s.d.=9.2) and included psychiatrists, GPs, psychologists and counsellors. Although participants’ knowledge of EDs was moderately good overall, responses showed poor recognition of the symptoms of EDs compared with depression [χ2 (4, n=127)=20.17, p<0.001]. Participants viewed EDs as chronic disorders that primarily affected females. Participants believed that clinicians like working with patients with depression and diabetes more than with AN patients [F (4,101)=5.11, p=0.001]. Among the professionals surveyed, psychiatrists were the most knowledgeable about EDs [F (4,82)=9.18, p<0.001], and were more confident in their ability to diagnose and treat EDs than professionals of all other disciplines, except psychologists [F (4,85)=8.99, p<0.001]. Psychiatrists were also the most pessimistic about ED patients’ long-term life prospects [χ2 (4, n=65)=15.84, p=0.003].

This study recommends that specific attention should be given to EDs in professional educational programmes across healthcare disciplines. This training should not be restricted to improving healthcare professionals’ knowledge of EDs, but should also strive to increase service-providers’ awareness of how their own potentially stigmatising attitudes can undermine engagement with treatment.

Visual hallucinations are a common phenomenon, among the older adult population. They can be functional or organic in aetiology. However, new onset visual hallucinations in this population are strongly suggestive of organic brain disease. Visual impairment, cerebrovascular disease and Parkinson’s disease are three causes of visual hallucinations, considered in this case series. The evidence in the literature, for the treatment of these conditions is scant at best. There is a paucity of randomised controlled trials available concerning possible therapeutic options.

We describe three case reports of visual hallucinations due to diverse underlying aetiologies. We then discuss the aetiologies of visual hallucinations in general and then in these particular cases and finally include results of a literature search examining the available evidence for any therapeutic options proposed.

Our three cases have different, underlying aetiologies. One case is of Charles Bonnet syndrome. The next is of visual hallucinations associated with vascular dementia. The final case is of visual hallucinations associated with Parkinson’s disease. The first two cases are of particular interest due to the efficacy of Amisulpride in both clinical scenarios.

Visual hallucinations are a common phenomenon in the elderly population

They can be due to a myriad of underlying causes. There are a number of neurochemical factors and neuroanatomical structures implicated. The evidence for psychopharmacological interventions is scanty. Randomised controlled trials are lacking in the area. An interesting finding in this case series, was of the clinical utility of Amisulpiride. Given this agent’s unique psychopharmacological profile it is possible that it may be efficacious in other cases of visual hallucinations associated with particular neurochemical factors.

The purpose of this paper has been to identify and describe the demographic, social and clinical characteristics of persons admitted to an Irish district lunatic asylum in the late 19th century as exemplified by the records of the Sligo District Lunatic Asylum. Some 21st century comparisons and epidemiological considerations from the same catchment area have been attempted.

The register entries and case books of a series of consecutive admissions to Sligo District Asylum during the decade 1892–1901 were surveyed in the Irish National Archive.

Most admitted patients were of lower socio-economic status, the majority male, poorly literate, unmarried and described as suffering from mania or melancholia. Most were first admissions. The predominant (62.5%) reason given for admission was for assault or threat of assault. These admissions were by order of the Lord Lieutenant as ‘dangerous lunatics’. Although it may be maintained that this admission process was a device of social convenience to maintain the peace and integrity of local communities and the convenience of families, clinical information indicates that the majority of admissions had symptoms of mental disorder recognisable in terms of 21st century psychiatric diagnostics.

To describe and discuss the portrayal of psychiatric illness in film and theatre.

A review of psychiatric literature on psychiatric illness and stigma was carried out. This was combined with a review of selected films and plays. The dramatic function of mental illness, and the manner of its portrayal, were considered in a discursive manner.

From Ancient Greek theatre to modern film, psychiatric illness has been used to exemplify “otherness”. This has frequently had connotations of danger and violence, either to others or to societal norms. Occasionally psychiatric illness is depicted as transformative, or an understandable reaction to an insane environment, and there is a trend towards more nuanced depictions of mental illness. However, the disproportionate association of mental illness with violence and danger is reflected in the public's perception of mental illness, and contributes to self-stigmatisation.

Ongoing communication between psychiatry, service users and the arts may help to challenge the stereotype of “mad, bad and dangerous to know”.