Tardive dyskinesia is a neurological disorder characterised by involuntary and purposeless movements affecting any part of the body. These movements typically occur in the oro-facial area and the patient is usually unaware of them. There are inconsistent findings in the literature on the risk factors for developing tardive dyskinesia. Nevertheless, previous reports indicate that tardive dyskinesia is more common in female patients, patients with a history of alcohol and substance misuse, affective disorders, and intellectual disability. The dose, class and duration of antipsychotic nmedication may also be independent risk factors. We report on the case of a patient who developed tardive dyskinesia on a low dose of the second generation antipsychotic risperidone.

Objectives: This study was carried out as part of a collaborative European study, with the aim of assessing needs in a population with chronic schizophrenia in the context of a community service, and also to measure service use in this population.

Method: This is the first part of a 12 month follow-up study of a sample of persons with schizophrenia who were in contact with the psychiatric services. Seventy eight patients who matched the inclusion criteria were randomly selected and 64 (82%) were interviewed using the Schedules for Clinical Assessment in Neuro-Psychiatry (SCAN) and the Needs for Care Assessment Schedule (NCAS). Service use data for a 12 month period were collected prospectively using the Mannheim Service Recording Sheet (MSRS).

Results: The levels of clinical and social need were quite low at 2.1 and 2.6 respectively. Most needs were met; unmet need was 0.11 for clinical problems and 0.4 for social. Service use was high, with a total of 6,969 contacts with community services, a mean of 109 per patient per year. Total service use (including inpatient and hostel) was partly predictive of met need (R2 23.6). The levels of met and unmet need in Dublin compare favourably with that reported in Mannheim and Granada. Service use was similar to that in Mannheim, although there was a higher level of service provision in Mannheim.

Conclusions: This study has shown that there is a low level of clinical and social need in this sample of patients with schizophrenia living in the community, and a relatively high level of service use. There is good evidence that services are meeting the needs of this sample of patients.

Objectives: Psychiatric hospitalisation rates in Ireland have been high. Recent studies indicate that this is not a consequence of raised incidence. This study explored the possibility that poor outcome may have been responsible for this high hospitalisation prevalence.

Method: Through participation in the WHO Study, Determinants of Outcome of Severe Mental Disorders (DOSMeD), we followed up a cohort of 67 first-onset schizophrenic patients over 15 years to determine symptomatic and functional outcomes and to compare these with outcomes of the cohorts recruited to the International Study of Schizophrenia (ISoS).

Results: Thirty-seven (55%) of the original 67 were successfully followed up over 15 years and, of these, 43% were continuously psychotic for most of the period; a similar proportion had recurrent episodes of illness; two-thirds of subjects had moderate to severe symptoms for most of the time; and, in terms of functional outcome, over four-fifths were unemployed at follow-up.

Conclusions: Outcome for the majority of followed-up patients was poor in symptomatic and functional terms. While this outcome was one of the poorest among the DOSMeD groups the question whether functional psychotic illness outcome is inherently poorer in Ireland than elsewhere remains unanswered. The high rate of attrition (45%) from the group during the follow-up period vitiated interpretation of outcome overall. The high number of suicides among the group was noteworthy.