Objectives: It is increasingly important to develop predictors of treatment response and outcome in schizophrenia. Neuropsychological impairments, particularly those reflecting frontal lobe function, appear to predict poor outcome. Eye movement abnormalities probably also reflect frontal lobe deficits. We wished to see if these two aspects of schizophrenia were correlated and whether they could distinguish a treatment resistant from a treatment responsive group.

Methods: Ten treatment resistant schizophrenic patients were compared with ten treatment responsive patients on three eye movement paradigms (reflexive saccades, antisaccades and smooth pursuit), clinical psychopathology (BPRS, SANS and CGI) and a neuropsychological test battery designed to detect frontal lobe dysfunction. Ten aged-matched controls also carried out the eye movement tasks.

Results: Both treatment responsive (p = 0.038) and treatment resistant (p = 0.007) patients differed significantly from controls on the antisaccade task. The treatment resistant group had a higher error rate than the treatment responsive group, but the difference was not statistically significant. Similar poor neuropsychological test performance was found in both groups.

Conclusions: To demonstrate the biological differences characteristic of treatment resistance, larger sample sizes and wider differences in outcome between the two groups are necessary.

Objectives: To describe a home-based treatment (HBT) service. To profile the patient population using HBT. To determine why HBT was used and to record disposal.

Method: All patients treated by HBT during the first two years of this new service were identified from the HBT logbook. A checklist recording demographic, diagnostic, presenting complaint data and details of HBT contact was used to analyse the patients' charts. A statistical package JMP was used to analyse the data.

Results: Two hundred and six patients (275 episodes) were treated using HBT. These were 101 (49.1 %) males and 105 (50.9%) females. Of these, 89 (43.2%) were single. Forty-eight (19.4%) lived alone and 53 (25.7%) were unemployed. The most common presenting complaint was severe depression (39.3%). A depressive disorder was the most frequent diagnosis (28.7%). Twenty six (13%) episodes of HBT ended in admission. One hundred and eighty five (67.3%) were referred to outpatients and 26 (9.5%) were discharged to the GP.

Conclusions: Home-based treatment is feasible for a wide range of patients with an array of presenting complaints. This model of service delivery is viable in a rural setting. Admission will still be required for some patients. Further work is needed to examine its sustainability and its generalisability to other Irish settings.

Objectives: To update the 20 year-old maxim that the majority of patients who undertake self-poisoning have recently seen their general practitioner, and to determine the patients' expressed reasons for consulting the doctor.

Methods: Two-stage cross-sectional survey: first, to find out from all self-poisoning patients whether they had recently attended their general practitioner; second, to determine, in a sub-sample of those who had attended, why they made their most recent consultation. The subjects were consecutive adult patients who were admitted to the general hospital in the City of Bradford as a consequence of self-poisoning.

Results: Overall 125/237 (53%) patients reported a consultation with their general practitioner in the previous month, and 61 of the 237 (26%) were within the last week. Patients recounted that their main expectations when consulting were to do with prescriptions, sick-notes and physical check-ups.

Conclusions: Although many of those who undertake self-poisoning consult their general practitioner shortly beforehand, a preponderance of physical complaints may render anticipation of the self-poisoning a difficult task.

Objectives: Treatment resistant depression (TRD), commonly encountered in clinical practice, leads to socioeconomic disability and therapeutic pessimism. This paper reviews evidence for pharmacological approaches used in TRD.

Method: Electronic literature searches were performed using Medline and Psychlit using broad search terms relating to TRD.

Results: Agents that potentiate both serotonin and noradrenaline may allow more patients to achieve full remission. Attention must be paid to dose titration and length of treatment courses in TRD. Augmentation with lithium and switching within antidepressant class or between classes can often improve symptoms but efficacy of other augmentation approaches remains uncertain. Antidepressant combinations and addition of atypical antipsychotics can be useful but combinations of predominantly serotonergic antidepressants should be avoided. Electroconvulsive therapy retains an important role in TRD but pharmacological treatments need to be continued concomitantly.

Conclusions: Good improvement is seen in TRD after vigorous antidepressant treatment but most patients continue to have lower grade symptomatology.

Atypical antipsychotic drugs are recommended for the first line treatment of all patients with schizophrenia. This is because it has been demonstrated that atypical antipsychotic drugs are more effective across a broader range of symptoms of schizophrenia than typical antipsychotic drugs and because they are dramatically less likely to cause the extrapyramidal and endocrine side effects that greatly impair quality of life for patients and reduce their willingness to adhere to maintenance treatment. Atypical antipsychotic drugs are not perfect but they are the most effective and the safest treatment for schizophrenia presently available.

The atypical antipsychotic drugs currently marketed in Ireland for the first line treatment of schizophrenia include amisulpride, olanzapine, quetiapine, risperidone and ziprasidone. These agents differ somewhat in chemical class, indications, daily dose range, need for titration, daily dosing regimen and available formulations (see Table 1). Clozapine is marketed for patients unresponsive to, or intolerant of, other antipsychotic drugs and must thus be regarded as a second line treatment for schizophrenia. Zotepine is not yet available in Ireland while the marketing of sertindole has been suspended following reports of arrhythmias and sudden cardiac deaths.

Alan Turing was born in Paddington, London on June 23, 1912 . His family were middle-class and well-off. He was fascinated with science from an early age and showed precocious talent, especially in the areas of chemistry and mathematics. He attended Sherbourne Public School and then King's College, Cambridge where he studied mathematics. His areas of interest at Cambridge were probability theory and mathematical logic. It was at Cambridge that he first conceptualised the Universal Turing Machine, an idea that was to evolve into the modern theory of computing. He has been referred to as the father of the computer.

He worked on a cipher machine at Princeton University between 1936 and 1938. He worked for the British Government during World War II with the Government Code and Cipher School at Bletchley Park. He was ultimately the key player in deciphering the German 'Enigma' code used by its submarines during the war. After the war he took up a post in Manchester University where he continued to work on ideas of artificial intelligence. He was arrested and charged for homosexual activity in 1952 and underwent a course of oestrogen therapy. He committed suicide in 1954.

He was regarded as being socially aloof and eccentric by colleagues and friends. He was interested in mathematics, chemistry and logic from an early age, to the exclusion of other activities. This paper attempts to establish whether he fulfilled the criteria for Asperger's syndrome.

We report the case of an 85 year old woman, admitted to hospital with a two month history of a depressive illness. Within one week of commencing treatment with citalopram 20mg daily, she had developed a widespread rash, bilateral ankle oedema and a range of biochemical and haematological abnormalities, including marked elevations of plasma urea and creatinine and increased neutrophil and eosinophil counts. Following withdrawal of citalopram, her physical state returned to normal within two weeks. The episode is suggestive of acute interstitial nephritis triggered by citalopram, a phenomenon not previously reported in association with the selective serotonin reuptake inhibitors.

We describe a case of adult twins presenting simultaneously with profound psychological disturbance following sudden separation. Formulation is made of a catastrophic adjustment reaction manifesting as depression in one sibling and anxiety in the other. An alternative possibility of acute onset psychosis in one or both of the twins is discussed.

Both epilepsy and dementia are common after the age of 65. Epilepsy, originating in the temporal lobes, can present clinically in a variety of ways and can be difficult to diagnose. Loss of consciousness may not be evident. Reported here is a unique case of a 65 year old man who presented with clinical features of frontotemporal dementia but was subsequently diagnosed as suffering from complex partial seizures. He made a full recovery with antiepileptic treatment.