Objective: Diogenes syndrome or the senile squalor syndrome is characterised by gross self neglect, domestic squalor and social withdrawal. Two series of such patients have been described in Britain. This paper examines the frequency and characteristics of the syndrome in an Irish urban population and discusses the management issues involved. Method: Detailed demographic, social, medical and psychiatric data was collected on all patients fulfilling the criteria for Diogenes syndrome who were referred to the North Dublin Old Age Psychiatry Service over a two year period 1989-1990. Results: Twenty nine cases (5% of all referrals) were identified giving an incidence rate of 0.5% per annum. Most were single or widowed (83%), and living alone (72%). 79% were known to the public health nurse and 59% had at least one medical problem. The commonest reason for referral was self-neglect. Thirteen suffered from senile dementia, three had schizophrenia, three were alcohol dependent and 10 had no psychiatric diagnosis. Subsequently, 12 patients remained at home, 12 moved into residential care and five died. Conclusion: The patients in this Irish series resemble those in the two British series. Management issues emphasised are the need to consider each patient as an individual and to balance risk with the right to self-determination. The role of care teams for the elderly in overall management is discussed.

The COVID-19 pandemic is a global health emergency, the scale, speed and nature of which is beyond anything most of us have experienced in our lifetimes. The mental health burden associated with this pandemic is also likely to surpass anything we have previously experienced. In this editorial, we seek to anticipate the nature of this additional mental health burden and make recommendations on how to mitigate against and prepare for this significant increase in mental health service demand.

The concept of recovery has gained increasing attention and many mental health systems have taken steps to move towards more recovery oriented practice and service structures. This article represents a description of current recovery-oriented programs in participating countries including recovery measurement tools. Although there is growing acceptance that recovery needs to be one of the key domains of quality in mental health care, the implementation and delivery of recovery oriented services and corresponding evaluation strategies as an integral part of mental health care have been lacking.

It is 20 years since the first references to elder abuse appeared in the medical literature. Since then there h as been a growing realisation that although most elderly people are cherished by their families a substantial minority are at risk of abuse. Prevalence studies in different countries have suggested that approximately 5% of those over 65 may be subjected to various forms of abuse including physical, verbal, financial abuse and neglect.

Objectives: To ascertain the relationship between social network type and depression over time.Method: A longitudinal outcome study of depressed elderly patients attending an old age psychiatric service was carried out. Subjects were seen at baseline and regular intervals over two years.Results: Depression severity at baseline and at follow-up times differed according to subjects' social network. Those with more socially integrated networks had the best outcome and those who had more dependent networks had a poorer outcome. There was a lot of movement between networks over time for subjects, with many moving towards more dependent networks.Conclusions: When treating depression in the elderly it is important to consider the social network and milieu in which the patient resides. Treatments should include strategies encouraging the maintenance and formation of social integration.