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Aims This study aimed to analyse trends in mental health presentations to the Emergency Department (ED), which anecdotally had increased over the past decade. Methods The ED's electronic 'Symphony' system was used to identify the annual number of presentations categorised as having a mental health complaint from 2006-2017. A detailed analysis was performed on presentations over a one-year period. Results The number of presentations increased from 69 in 2006 to a peak of 432 in 2016 (526% increase). The overall admission rate was 33.3%(n=99), while 52.5%(n=156) of presentations occurred outside of standard working hours. Similar increases were documented by other ED's worldwide, and the WHO estimate that neuropsychiatric disorders will become one of the top five causes of morbidity, mortality and disability among children by 2020. Conclusion With the number of mental health presentations dramatically increasing, carefully designed and integrated strategies are required to pro-actively tackle this growing epidemic., Competing Interests: The authors declare that there are no conflicts of interest.

Advance directives such as do not resuscitation orders are becoming more common place in Irish Hospitals. A questionnaire was completed by all 44 interns working in St James' Hospital in January 2010 and by 49/50 Senior House Officers in June 2010.3/44 of interns (6%) and 5/49 (10%) SHO believe that there is no difference between palliative patients and NFR patients. 41/44 interns (93%) and 40/49 of SHOs (81%) believe that attitudes of treating staff change once a patient is listed as NFR. 14/44 of Interns (32%) and 15/49 SHOs (31%) think that nursing staff are reluctant to request a review when these patients become unwell. They were asked if someone listed as NFR became unwell, what would be an appropriate intervention using a grading system. Interns and SHOs appeared to be reluctant to make basic interventions such as blood tests, blood cultures or even oral antibiotics in this sub group of patients. This questionnaire demonstrates that NFR patients are potentially treated differently and possibly under treated by Junior Doctors. The question remains how to balance the best interests of the patient. If NFR status results in under treatment does it cause more harm than good.

Dopa decarboxylase (DDC) is an enzyme which catalyses the decarboxylation of both dopa to dopamine and L-5 hydroxytryptophan to serotonin. Both catecholamines are major neurotransmitters of the mammalian nervous system. It has been suggested that genes involved in the dopaminergic system play a primary role in predisposing to attention deficit hyperactivity disorder (ADHD). In this study, the 4-bp insertion/deletion variant mapped to the first neuronally expressed exon 1 at the dopa decarboxylase gene and two microsatellite markers flanking the gene were investigated for possible association with ADHD. Using HHRR, we observed an increased transmission (though not significant) of the 4-bp insertion (allele 1) to ADHD cases (chi(2) = 2.72, P = 0.1, RR = 1.25). However marginally significant excess transmission of allele 10 (213 bp) of the 3' microsatellite D7S2422 ( approximately 0.75 cM distal to dopa decarboxylase gene) was found (chi(2) = 4.2, P = 0.04, RR=1.48). Interestingly, a haplotype containing both alleles is transmitted more frequently (chi(2)= 5, P = 0.025). Analysing data by the sex of transmitting parent showed a greater relative risk for paternal transmission of the 4-bp insertion allele and allele 10 of the D7S2422 (RR = 1.48 and 1.63 respectively). This provides preliminary evidence that this locus or a closely mapped DNA variant may be involved in the genetic susceptibility to ADHD. However, further studies are required to either confirm or refute these observations.