Dialectical behaviour therapy (DBT) is a multi-modal psychological therapy with established efficacy in treating borderline personality disorder (BPD). Younger adults represent a group more likely to drop out of treatment than their older counterparts and treatments specifically targeted at this younger cohort may be advantageous.

We describe an evaluation of a DBT programme in a mental health centre for younger adults 18–25 years who met criteria for BPD (n=11).

We used a simple pre/post-test design, measuring BPD symptoms, general mental health symptoms, and coping skills using self-report questionnaires at the beginning of DBT and again following the delivery of 22 weeks of DBT.

Statistically significant reductions were found in BPD symptoms and several mental health symptoms alongside an increase in DBT skills use. Dropout was 31% at 22 weeks of treatment. Methodological weaknesses and avenues for future research are discussed.

In children and adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD), the comorbidity of the oppositional defiant disorder (ODD) negatively affects the course of ADHD. The purpose of this study was to compare ADHD-diagnosed children with and without ODD comorbidity in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries.

This study included 109 children diagnosed with ADHD alone and 79 children with the ADHD-ODD comorbidity from a child psychiatry outpatient clinic. The children who participated in the study were aged between 6 and 15 years. Diagnoses of the children were determined by child psychiatrists according to DSM-IV criteria, and the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form was used to support the diagnosis in initial evaluations of children. Forty-six to fifty months after the first admission, parents were questioned regarding all negative outcomes from the time of first diagnosis to the time of the evaluation by phone.

The groups were compared in terms of smoking, psychoactive substance use, disciplinary punishments at school, criminal behaviors, and unintentional injuries over a period of 4 years. The ODD-ADHD group was determined to have higher rates of disciplinary punishments at school, smoking, and unintentional injuries compared with the ADHD group. No statistically significant difference was found between the two groups in terms of criminal behaviors and psychoactive substance use.

The ODD comorbidity increases the risk of negative outcomes in children diagnosed with ADHD.

The purpose of this pilot study was to evaluate a 12-session group-based motivational intervention for substance misusers in a prison setting. The intervention aimed to increase both participants awareness of problem substance use and motivation to change their substance use behaviour.

Participants were recruited for the intervention through active outreach in the prison. Participants of the intervention group completed a structured interview before the group commencing and standardised pre- and post-outcome measures. The results of the intervention group (n=31) were compared with a waiting list control group (n=11).

Non-parametric analysis showed retention rates on this programme at 2, 4 and 6 weeks were 88%, 79% and 76%, respectively. Outcome data were consistent with the predicted direction for the treatment group compared with the wait-list control with significant between-group differences found on ambivalence and taking steps scores.

This group-based intervention demonstrated positive levels of client engagement and retention. The intervention was also successful in reducing participant ambivalence about their drug use. Implications for service provision are discussed and design limitations of the present study are considered. Overall, findings indicate the potential utility of a group-based motivational intervention for substance misusers in forensic settings.

Little is known about the involvement of security personnel in Irish psychiatric care. Content analysis of inspection reports is a feasible way to investigate this under-researched topic. We aimed to (i) Describe the number of approved centres per year in which we observed comments about the presence of security personnel in published reports of inspections conducted from 2008 to 2012 (ii) Report the main themes of all text relating to security personnel published in these inspection reports.

We conducted a content analysis of all 349 inspection reports published between 2008 and 2012.

The number of approved centres in which security personnel were noted increased from 3% to 8% between the years 2008 and 2012. This increase was not statistically significant when the same unique centres were compared between years (p=0.684). Employment details such as contracted employment relationship, location relative to the approved centre and hours of work appeared inconsistent across centres. Role functions of security personnel differed across centres and ranged from monitoring the entrance of a unit to observing, restraining and secluding patients. Contrasting perceptions of suitability were evident in the inspection reports. The extent to which the training needs of security personnel were met was unclear from the reports.

Activity of security personnel in psychiatric hospitals may not be role appropriate, compliant with legislation or conducive to treatment. Best practice guidelines should be developed in consultation with multiple stakeholders.

There has been a recent move in psychiatry towards the use of electronic discharge (e-discharge) summaries in an effort to improve the efficiency of communication between primary and secondary care, but there are little data on how this affects the quality of information exchanged.

To evaluate the quality of psychiatric discharge summaries before and after the introduction of the e-discharge summary system.

A retrospective analysis of 50 dictated discharge summaries from 1 January to 1 July 2010 and of 50 e-discharge summaries from 1 January to 1 July 2012, evaluating for the inclusion of 15 key items of clinical information.

The average total score of the dictated summaries (mean=9.5, s.d.=2.0) was significantly higher (p<0.001) than the e-discharge summaries (mean=6.7, s.d.=1.8). There were statistically significant differences in five of the standards: findings of physical examination (p<0.001), ICD-10 code (p<0.001), forensic history (p<0.001), alcohol history (p<0.001) and drug history (p<0.001).

Our results revealed a decline in the quality of discharge summaries following the introduction of an electronic system. The reasons for this are unclear and require further analysis. Specific suggestions will depend on the local need, but include improvements in software design and layout as well as better education and training.

This audit cycle looked at details of antidepressants given in general practitioners’ (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.

To evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.

Audit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.

The April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.

Our interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.

In this case report we attempt to emphasize the unfamiliar link between trazodone and relapse of psychotic symptoms.

Case report and literature review of relevant papers.

We report a case of a 78-year-old woman with an established diagnosis of paranoid schizophrenia who has experienced an exacerbation of positive psychotic symptoms following initiation of 50 mg dailydose of trazodone. We noted that psychotic symptoms abated following discontinuation of trazodone.

Trazodone use in patients in remission from schizophrenia may be associated with relapse of psychotic symptoms and caution is required.

International figures for involuntary admissions vary widely. Differences in legislation, professionals’ ethics and public attitudes towards risk have been known to influence this rate. Comparing involuntary admission rates in different parts of the same country can help control for variability found between international studies. This study assessed the rates of involuntary admissions in the Dublin South West Mental Health Service compared with the rest of Ireland.

We examined the demographic and clinical profiles of all involuntary patients admitted to the acute psychiatric inpatient unit in Tallaght Hospital between 2007 and 2011. We compared the rate of admission in Tallaght with the rest of Ireland. Data gathered included all patients detained on Form 6 and Form 13 (change of status) looking at age, gender, diagnosis and number of patients who had a Mental Health Tribunal. Form 7 (renewal orders) was also examined

We calculated the rate per 100 000 population per year of Form 6 admissions, Form 13 and Form 7 (certificate and renewal order by responsible consultant psychiatrist) using figures from the 2006 Census. All data were analysed using SPSS.

The rate of involuntary admission in Tallaght Hospital was significantly lower compared with the rest of Ireland (Form 6: t=−11.2; p<0.001, Form 13: t=−3.1; p=0.04, Form 7: t=−13.9; p=0.001). This difference was evident for all methods of involuntary detention and was also the case for Form 7 (renewal orders). Mental Health Tribunals were held for 59% of patients, a rate comparable with earlier findings described in publications, following the introduction of the new Mental Health Act.

Rates per 100 000 population were lower in Dublin South West compared with the rest of Ireland. The reasons for this are not clear. Further research comparing similar services in Ireland could explain these findings.

This paper reviews the decline in numbers in inpatient psychiatric care in Ireland over the past half century.

The relevant policy publications advocating de-institutilisation have been examined. Change has been monitored through successive census reports of the Medico-social Research Board and the Health Research Board.

Ireland has moved from having the highest hospitalisation rate of any western country to a position of equality with other comparable countries in the quantum of inpatient care provided. In the public sector virtually no patients remain in 19th century mental hospitals with acute care being provided in general hospital units. Numbers have also decreased in the private sector but to a lesser degree and acute private care is still delivered in stand-alone psychiatric hospitals.