Eugene G. Breen

Screening for metabolic syndrome in long-term psychiatric illness: Audit of patients receiving depot antipsychotic medication at a psychiatry clinic

Background and Objectives: Metabolic syndrome (visceral obesity, dys- lipidaemia, hyperglycaemia, hypertension) is a substantial public health problem, espe- cially amongst individuals receiving antipsychotic medication. Methods: We studied routine screening practices for metabolic syndrome amongst psy- chiatry outpatients receiving injected depot anti-psychotic medication at a clinic in Dublin, Ireland. Results: Our initial audit (n = 64) demonstrated variable levels of documentation of crite- ria for metabolic syndrome in outpatient files; e.g. weight was recorded in 1.6% of files, serum high density lipoprotein in 12.5%. As our intervention, we introduced a screening check-list comprising risk factors and criteria for metabolic syndrome, based on the defini- tion of the International Diabetes Federation. Re-audit (n = 54) demonstrated significantly improved levels of documentation; e.g. weight was recorded in 61.1% of files. Notwith- standing these improvements, only 11 (20.4%) of 54 patient files examined in the re-audit, contained sufficient information to determine whether or not the patient fulfilled criteria for metabolic syndrome; of these, 3 patients (27.3%) fulfilled criteria for metabolic syndrome. There was, however, significant additional morbidity in relation to individual criteria (waist circumference, serum triglyceride level, systolic blood pressure and serum fasting glucose). Conclusions: We recommend enhanced attention be paid to metabolic morbidity in this patient group.

Legal limits for paracetamol sales

In Ireland, there were 7933 recorded cases of drug overdose in 2004, of which 31% involved paracetamol.4 It is against the law for pharmacies in Ireland to sell more than 24 paracetamol (500 mg) tablets in a single transaction.5 In early 2007, we visited 20 pharmacies in Dublin and attempted to purchase amounts of paracetamol in excess of this legal limit: ten pharmacies allowed us to do so.

Dr Ada English: patriot and psychiatrist in early 20th century Ireland

Dr Adeline (Ada) English (1875-1944) was a pioneering Irish psychiatrist. She qualified in medicine in 1903 and spent four decades working at Ballinasloe District Lunatic Asylum, during which time there were significant therapeutic innovations (eg. occupational therapy, convulsive treatment). Dr English was deeply involved in Irish politics. She participated in the Easter Rising (1916); spent six months in Galway jail for possessing nationalistic literature (1921); was elected as a Teachta Dála (member of Parliament; 1921); and participated in the Civil War (1922). She made significant contributions to Irish political life and development of psychiatric services during an exceptionally challenging period of history. Additional research would help contextualise her contributions further.

Liverpool care pathway is a nice idea--pity about the practice.

The idea of optimal palliation during the final days of life makes good medical sense and should be the end of a continuum of best practice.1 The idea of making someone comfortable and easing suffering sounds good. Relatives like to think their loved ones are at peace. This is the plan, but who will diagnose “dying” and what internationally accepted criteria will be …

Graphology and psychiatric diagnosis: Is the writing on the wall?

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. Ms 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.

P02-03 Brain imaging in clinical psychiatry: Why?

Aims To explore clinical indications for, and results of, brain imaging in a department of general adult psychiatry. Method We reviewed the 100 most recent episodes of brain imaging at the Department of General Adult Psychiatry, Mater Misericordiae University Hospital, Dublin. Results Patients had a mean age of 55.30 years. The most common indications for scans were cognitive impairment (33%) and other neurological concerns (e.g. seizures) (30%). Forty-seven per cent of scans were abnormal. The most common abnormalities were ischaemia (17%) and atrophy (10%). Patients with abnormal scans were older than those with normal scans (61.90 and 48.70 years, respectively; p Conclusion Brain imaging contributes significantly to diagnosis in general adult psychiatry, especially for older patients.

GMC guidance on beliefs: Denies conscientious objection.

The recent ethical guideline of the General Medical Council puts doctors in an impossible position.1 The giving of information or aiding someone to obtain a service the doctor considers immoral contravenes the essence of conscientious objection. The doctor’s right to have his moral code respected, provided that it isn’t spurious or lacking a credible evidence base, is a basic human right.