The potential for antimicrobials to adversely affect mental state.

This is a case report highlighting the influence that antimicrobials (clarithromycin in particular) can have on one's mental state. We discuss the case of a middle-aged woman who presented to an acute admissions unit under Irish Mental Health Act for involuntary admission because of concerns expressed by her family and general practitioner regarding a recent change in behaviour and onset of irritable mood. This lady was diagnosed with an episode of mania that was thought to be precipitated by a combination of psychosocial stressors, recent discontinuation of psychotropic medication and complicated by a recent course of clarithromycin.

Psychoeducation: priorities of service users and service providers.

OBJECTIVES: The objective of this study was to ascertain the topics patients and mental health professionals thought should be covered in a psychoeducation programme at a day hospital. METHODS: Patients at the psychiatric day hospital and mental health professionals were invited to complete the study questionnaire. Replies from 101 participants were analysed. RESULTS: The patients and mental health professionals generally agreed regarding the topics to be covered in the eight-week psychoeducation programme. Patients tended to score 'suicide' as more important than did the mental health professionals. CONCLUSIONS: Patients in a day hospital setting and mental health professionals share similar concerns about what information needs to be imparted about the patients' illnesses. However, suicide is seen by patients as a more important topic in such a setting.

Psychiatric aftercare and suicide risk: a case-control study using blind rating.

Blindly abstracted records of last episode of care together with aftercare records of 39 psychiatric patient suicides and their matched controls were rated blind for suicidal talk during aftercare, reduction of aftercare at last appointment and high-low suicide risk. Neither suicidal talk nor reduction of aftercare was confirmed as a predictor of suicide, although trends in the predicted directions were observed. Blind estimates of high-low risk correctly identified a significant minority (40%) of suicides but at the cost of misclassifying 60% as controls. Evidence is still lacking that clinicians blind to case identity may, from records, reliably distinguish a majority of suicides from their matched controls. Some implications for practice and research are discussed.

Attitudinal change toward psychiatry during undergraduate medical training in Ireland.

OBJECTIVES: This study examined the impact of psychiatric teaching on attitudes toward psychiatry of a cohort of medical students by means of a questionnaire survey. The impact of social desirability bias on questionnaire responses was also explored. Gender and nationality subgroups in the cohort were examined in more detail to determine whether these variables had any bearing on attitude change. METHODS: Fifth year medical students at NUI Galway completed the Attitudes to Psychiatry-30 questionnaire at the beginning and end of the psychiatric curriculum. This was coupled to the Marlowe-Crowne Social Desirability Scale (13 items) to determine the effect of this potential bias on responses to the attitudinal scale. Anonymity was ensured by using unique identification codes on the questionnaires, which facilitated individual comparisons of pre- and post-teaching responses. RESULTS: Attitudes toward psychiatry were positive prior to training but significantly improved following the teaching programme. There was no difference in attitudinal change between male and female subgroups. While students from outside the EU did show an improvement in mean scores on the ATP-30 this increase failed to reach significance. This finding was in contrast to the results for students from EU states whose mean increase on the ATP-30 was highly significant. Social desirability questionnaire scores fell significantly between the first and second administration, lending support to the findings being a true reflection of the students' attitudes toward psychiatry. CONCLUSIONS: These findings suggest that a teaching programme has the ability to influence students' attitudes. This is encouraging for recruitment into psychiatry and overall patient care.

Can suicides be identified from case records? A case control study using blind rating.

A majority of case control studies of suicide risks in psychiatric patients reveal an excess of risk factors in cases. None of the case control studies has been conducted blind to case identity. The present study examined the possibility that skilled clinicians could identify suicides blind from case records of last episode of care. Records of 39 suicides of psychiatric patients and their matched controls (N = 78) were abstracted blind and dichotomously rated for suicide by seven raters. Success in identification of cases approximated to chance expectation. Pending replication, these disappointing findings call in question the clinical utility of risk factor findings to date, their validity as a basis for significant change in service provision and the medico-legal significance of records in suicide-related civil law suits.