Background: Evidence from regions where there have been severe dietary restriction suggests that individuals in utero during periods of starvation may subsequently be at increased risk of schizophrenia. Because Ireland was the location of a major nineteenth century famine an attempt has been made to determine whether any such evidence for famine/schizophrenia association can be found.

Method: The data used derive mainly from the Annual Reports on the District, Criminal and Private Lunatic Asylums supplied by the Inspectors of Lunacy in Ireland for the relevant years. Nineteenth century diagnostic labels have been adjusted to conform to schizophrenia as currently understood. Evidence relating to a possible schizophrenia increase in famine-related emigrants is examined.

Results: There was an increase in first admission rates for schizophrenia of 85.7% from 1860 to 1875. Admissions for other disorders, chiefly melancholia, also increased. Similar admission increases were evident in other jurisdictions over the same period. Data relating to the mental health of famine – migrating Irish are sparse and of difficult interpretation.

Conclusion: The evidence from available data sources attempting to link the Irish famines of the 1840s with a subsequent increase in the incidence of schizophrenia is equivocal and inconclusive.

Objectives: To describe the characteristics of patients who present to an approved centre with Mental Health Act 2001 forms, and secondly, to compare those who were subsequently detained to those who were not detained.

Methods: Specific data on patients who presented to South Lee Mental Health Unit with application and recommendation forms for Involuntary Admission over a 22 month period was gathered from a retrospective case note review. Information on both groups was compared statistically using Graph Pad Prism software.

Results: 71% (n=121) of patients presenting for involuntary admission did so outside of normal working hours. Those who were not subsequently detained were more likely to have had their application made by the Gardai and their recommendation made by someone other than their own General Practitioner (GP). GPs were more likely than Consultant Psychiatrists to cite risk to self or others as the reason for involuntary admission.

Conclusion: Although involuntary admissions most often occur in emergency situations, every effort should be made to ensure that those who are known to the patient are involved in the process of application and recommendation. In addition, there is a need for ongoing training and education of those most commonly involved, such as the Gardai and General Practitioners, as well as feedback to these groups when a patient presents who does not require involuntary admission.

Objective: To determine the prevalence of mental illness among the residents of a homeless hostel in inner city Dublin.

Method: A cross-sectional survey was carried out among hostel residents, as previous studies have indicated that homeless hostel-dwelling men in Dublin constitute the largest single grouping of homeless Irish people. All agreeable residents were interviewed by the authors over an eight-week period using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Clinical Version. For each disorder, the current (30-day) and past prevalence was determined.

Results: A total of 38 residents were interviewed, resulting in a response rate of 39.2% for the study. A total of 81.6% of residents had a current Axis I diagnosis; this number increased to 89.5% when combining current and past diagnoses. Only four residents had no diagnosis. There was considerable comorbidity between disorders, with a significant number of residents experiencing both mental illness and substance use problems. When considering lifetime diagnoses, 31.6% had a single diagnosis only; 57.9% had two/more diagnoses. Twelve residents (31.6%) had been admitted to a psychiatric hospital during their lifetime. The most prevalent disorders during the past month were Alcohol Dependence (23.7%), Opioid Dependence and Major Depressive Disorder (both 18.4%), Opioid Abuse and Alcohol-Induced Depression (both 7.9%). Only 23.7% of interviewed residents were attending psychiatric or addiction services. A significant number of residents who did not wish to participate in the study were identified by hostel staff as having a confirmed psychiatric diagnosis.

Conclusion: The survey demonstrated a very high prevalence of mental disorders among homeless hostel residents. The high prevalence of dual diagnosis highlights the need for greater collaboration between psychiatric services and addiction services. The outcome also points to the importance of providing mental health training to emergency shelter/hostel staff. Research into the mental health status of the homeless should be undertaken regularly if services are to be planned to meet the needs of this vulnerable group.

Objectives: The aim of this study was to determine the views of both individuals attending the mental health services (attendees) and mental health professionals in relation to how attendees and staff should be addressed, how attendees should be described, and how staff should be attired.

Methods: We surveyed 132 attendees of the West Galway Mental Health Services and 97 mental health professionals in relation to how they prefer to be addressed (first name/ title and surname/ no preference) the description of attendees (patient / client / service user / no preference) and the attire of mental health staff (casual / smart / no preference). We also ascertained how mental health professionals believed attendees would view these issues.

Results: Attendees preferred to be described as patients rather than clients or service users by all mental health professionals, with 46-54% of attendees preferring this term “patient” compared to 14-17% preferring the term “client”, 11-13% preferring the term “service user” and 20-25% having no preference (p < 0.001). They preferred to address doctors by their title and surname (61%) but other mental health professionals by their first names (60-69%) (p < 0.001). Attendees had a strong preference for being addressed by their first names by all the mental health professionals (86-91%) (p < 0.001). Doctors preferred to be attired formally (88%), compared to nurses (50%) or other mental health professionals (42%) (p = 0.002). Attendees had no preference in relation to the attire of doctors but preferred other mental health professionals to be attired informally.

Conclusions: The study demonstrates that despite the increased use of several non-medical terms to describe attendees of mental health services; the preferred term of attendees of the psychiatric services in both in-patient and out-patient settings remains ‘patient’. However, this is not universally the case, and the ascertainment of the preference of the attendee at the first encounter with the health professional should be ascertained. We also demonstrated that attendees preferences in relation to both “dress and address” of doctors is significantly different to their preference for nurses or other allied mental health professionals; which may reflect a wish for a less familiar and more formal interaction with doctors.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.

Objective: This study was carried out to determine the prevalence of selective mutism (SM) in an urban school population and to assess comorbidity and family characteristics.

Method: Teachers of primary schools, teaching children between the ages of four and 12, were sent a description of SM and asked to complete the selective mutism questionnaire (SMQ) if they believed a child in their class met criteria. Thirty-nine schools were sampled, covering a catchment area of 10,927 children. Children who screened positive on the SMQ were offered a full psychiatric assessment. Parent, child and clinicians completed various rating scales.

Results: A response rate of 100% from schools was obtained. The prevalence rate of SM was 0.18% (20/10927). fourteen (70%) attended for further evaluation. All children scored within the clinical range on the Clinical Global Assessment Scale (CGAS), indicating moderate to severe impairment. fifty percent (7) reported a family history of social anxiety disorder, and 43% (6) autistic spectrum disorders.

Conclusion: This is the first Irish based prevalence study of SM. Results indicate that SM is not as rare as previously believed. Children with SM were found to have significant functional impairment along with a strong family history of anxiety and autism.

Objectives: Psychotherapeutic skills are essential to practice psychiatry effectively, but previous surveys of trainees in Ireland show that they have not been getting adequate training in psychotherapy. This survey of college tutors was carried out to coincide with the establishment of the College of Psychiatry of Ireland which is introducing new psychotherapy training requirements. The survey aims to ascertain if trainees had fulfilled the Royal College of Psychiatrists' psychotherapy training requirements, models of psychotherapy available and the availability of psychotherapy qualifications amongst consultants and senior registrars.

Methods: A questionnaire was posted to all registered tutors in the Republic of Ireland.

Results: The postal questionnaire was sent to the 62 registered college tutors in the 13 training schemes. There is one tutor in each training hospital. The response rate was 79%. Our survey reveals that no psychotherapy training was available according to 16.3% of tutors. Only 22.5% of tutors were aware of trainees who had met college training requirements in the previous two years. 79.8% of tutors reported that there were consultants and senior registrars with qualifications in psychotherapy who could offer training if time and resources permitted.

Conclusions: Current training requirements are not being fulfilled. There are consultants and senior registrars who have psychotherapy qualifications to provide psychotherapy training but there are inadequate resources and time to formalise training. It is unlikely that the implementation of training requirements by the new college will be realisable without a review of training delivery.

Objective: The aim of this exploratory study was to investigate the extent of suicide ideation, psychological maladjustment and views of mental health service support in a sample of secondary school pupils.

Method: A cross-sectional survey was conducted on a purposive sample of participants (n=93) recruited from a secondary school located in the south east of Ireland. Participants completed a Background Information Questionnaire (BIQ); the Suicide Ideation Questionnaire (SIQ); and the Reynolds Adolescence Adjustment Screening Inventory (RAASI).

Results: Approximately ten percent of participants displayed high levels of suicide ideation whilst one third reported having previously had suicidal thoughts; one quarter reported psychological adjustment difficulties, although these varied by age and sex. Participants' drug use and their levels of parental closeness were both individual factors that significantly predicted both suicide ideation and psychological adjustment. Females reported higher levels of parental closeness than males. Forty percent of respondents rated mental health support services as insufficient to meet their needs.

Conclusion: The findings raise serious concerns about the extent of suicidal thoughts amongst young people in Ireland; they also highlight a potentially important role for parents in this regard. Further research should ascertain national prevalence rates whilst appropriate school-based mental health education/promotion and support services should also be implemented.

Objective: To review the role of handwriting analysis in psychiatry.

Method: Case-report and review of key papers.

Results: M, a 27-year-old man, presented with incoherent speech, palilalia, logoclonia, incongruous affect, paranoid delusions and auditory hallucinations. M was diagnosed with schizophrenia and cannabis misuse, complicated by speech and language difficulties. M spent long periods writing on pieces of paper; towards the start of his admission, his writing was unintelligible but became more intelligible as his psychosis resolved. M's handwriting demonstrates clinical features of psychosis (e.g. clang associations) and graphological abnormalities associated with schizophrenia in the literature (rigidity in letter-formation, mechanical expressions, and tendency toward over-use of straight lines).

Conclusion: Analysis of handwriting is likely to play a limited role in psychiatric diagnosis but may prove useful in monitoring clinical improvement in certain patients.

One of the most important questions facing psychiatry today concerns its relationship to the emerging international service user movement. I believe that this movement presents not only the greatest challenge to psychiatry, but also the greatest opportunity. As it becomes more organised and influential this movement is starting to play a major role in shaping the sort of questions that are being asked about mental health services and their priorities. Yet there is limited reflection in our profession about how we, as doctors, might engage positively with it. It seems that while we are comfortable working with individuals and organisations who accept the medical framing of mental problems, we are less willing to contemplate working with critical service users. These are people who reject the medical model because they feel harmed by a system that describes their problems using the language of psychopathology. If we are serious about having an inclusive debate on mental health we will have to overcome this impasse. We need to entertain the idea that people who reject the medical framing of their problems are nevertheless legitimate stakeholders. It is time that we learned how to talk to them and to listen to their ideas. The user movement, with its substantial critical component, is not going to go away.

One of the most important elements of the relationship between psychiatric services and the people who use them is the reality of psychiatric power. Many critical service users accept that legally sanctioned interventions may be necessary when individuals lose capacity to care for themselves and perhaps put themselves or others at risk. However they do not accept the fact that the Mental Health Act in Ireland gives sole authority to doctors to take decisions on such interventions without any obligation to consult other interested parties.