Objective: To determine the prevalence of dementia in an Irish sample of Down's syndrome (DS) patients and to examine the utility of a number of cognitive and functional scales in the assessment of dementia in this population.

Method: 76 DS patients diagnosed clinically (range 33–72 years; mean age 47.3 ± 8.8 years) were included in the study. The diagnosis of dementia was made on clinical grounds using DSMIIIR criteria. Cognitive and functional impairment were evaluated using the following scales; Test for Severe Impairment (TSI), Down's Syndrome Mental Status Examination (DSMSE), Daily Living Skills Questionnaire (DLSQ), and the Mental State Performance (MSP).

Results: The overall prevalence of dementia was 7.9% (95% C.I = 2.95–16.39). The presence of dementia was associated with late onset epilepsy, anticonvulsant medication and deafness. Standard cognitive tests such as the MSP showed an early ‘floor’ effect in this population. In contrast the TSI and DLSQ showed a satisfactory range of scores in these patients with moderate to severe learning disability.

Conclusions: The low prevalence of dementia in this study may be explained by the strict conservative criteria applied in the clinical diagnosis. Prospective assessment of DS patients on a longitudinal basis using decline on scales such as the TSI and DLSQ may allow more accurate diagnosis of dementia at an earlier stage in this at-risk population.

Objective: The original DWR test, which measured delayed free recall, was reported to have high predictiveaccuracy in discriminating Alzheimer's disease (AD) patients from control subjects (overall accuracy of 95%).Comparison of differential performance in free recall and recognition of the same material may be of clinical interest. In the present study a delayed recognition component was added to the DWR test and the utility of both measures in discriminating AD patients from control subjects was evaluated.

Procedure: This extended version of the DWR test was administered to 66 patients meeting NINCDS/ADRDA criteria for probable AD and 42 control subjects.

Results: In a comparison between 42 of these patients (MMSE range 18–29), and 42 age matched healthy controls, both the delayed free recall and recognition measures were highly accurate in distinguishing patients from controls. The free recall measure achieved 98% sensitivity, specificity and overall accuracy, while the recognition measure yielded 98% sensitivity, 95% specificity, and 96% overall accuracy. The recognition performance of all 66 patients, ranging in severity from very mild to severe (MMSE range 11–29), was also evaluated to determine its relationship, if any, to measures of global cognitive impairment. While therecognition measure correlated poorly with MMSE and CAMCOG there was a modest but significant correlation with the CAMCOG memory subscale.

Conclusions: In this study of highly selected AD patients both the free recall and recognition measures were sensitive and specific indicators of AD compared to control subjects. Recognition performance appears to be more closely related to degree of amnesia than to degree of global cognitive impairment.

Objective: Examination of the process of therapeutic observation, as performed by nursing staff on acute assessment wards, from the perspective of adult inpatients.

Method: One week after admission, patients were asked to complete a questionnaire, enquiring whether they had noticed their observation, and the extent to which they found it intrusive. Diagnoses were categorised by ICD–9, from the case-notes. Chi-square was used to analyse the results.

Results: Fifty six per cent of patients perceived changes in the intensity of their observation. Psychotic patients were significantly more likely than the rest (p = 0.016) to feel that they were observed too closely, despite not being uncomfortable with this. There was a trend for patients in the traditional psychiatric hospital to feel more discomfort than those on a psychiatric ward in the district general hospital (p = 0.12).

Conclusion: Respect for privacy and dignity may notentirely be attainable for the most vulnerable group of psychotic patients. Opportunities may exist to improve matters with the closure of asylums and attention to ward layout and design.

Objective: Benzodiazepine misuse among opiate addicts is well described but few studies have reported on the occurrence and management of benzodiazepine dependence within this group. This study reports on the nature and extent of benzodiazepine dependence among a group of opiate addicts and describes the patients' treatment progress and requirement for substitute medication.

Method: Over a 12 month period routinely collected data on all admissions of opiate addicts to our inpatient treatment and research unit were searched. Specific details were then extracted for those 61 admissions who were opiate dependent and also currently misusing benzodiazepines.

Results: 26 (43%) of the 61 admissions were found to bephysically dependent on benzodiazepines. Temazepam and diazepam (respectively) were the most commonly misused preparations and 22% of those using temazepam were injecting it. Patients requiring detoxification were stabilised on doses of diazepam ranging from 20mg to 80mg daily (mean; 40mg). No correlation was found between reported use of benzodiazepines and the dose of diazepam required for stabilisation. Users found to be physically dependent on benzodiazepines more commonly reported daily use and use of two or more benzodiazepines concurrently.

Conclusions: Our findings suggest: 1) that benzodiazepine dependence occurs in opiate addicts with a frequency similar to that reported previously for other groups of benzodiazepine users; 2) that individuals using benzodiazepines on a daily basis may be more at risk of developing physical dependence; and 3) that clinically it is difficult to accurately predict requirements for substitute medication solely from patient's reported daily use prior to admission.

Objectives: The closure of long-stay mental hospitals has led to more patients with psychoses being cared for in the community. Although surveys have been conducted in the London area, little is known about the attitudes of general practitioners in provincial parts of the United Kingdom towards schizophrenic patients and their care.

Methods: A questionnaire was sent to all general practitioners in the St Helens area in north-west England.

Results: 94 doctors replied, 53% of those circulated. Only a minority consider that such patients cause them a great deal of work. Problems with medication were cited most often as causing difficulties for the general practitioners. Psychiatrists were considered to be the group with whom the general practitioners had the best communication, but also where they wished communication to improve further. Despite the shift towards community care, there was no clear trend in the amount of work created by schizophrenic patients perceived here.

Conclusions: Only a minority of those doctors surveyed found that schizophrenic patients cause them an undue burden of work. Perhaps developments in community based psychiatric services should be directed first at those general practitioners who report excessive problems from patients with long-term mental health problems.

Preoccupation with weight and shape is very prevalent in the female population and is generally well researched. However, the effects of eating psychopathology on infant growth and child development have not been adequately covered and they merit the attention and interest of clinicians. This present submission, using Medline search, critically reviews the available literature and highlights the importance of clinically addressing these issues. It also makes reference to other areas requiring further research. Fifteen articles are discussed which relate specifically to eating psychopathology and the possible effect on mother-child interactions.

Schizophrenia is thought to be the commonest setting in which delusional misidentification syndromes occur. Although schizophrenia is said to occur more commonly in people with learning disabilities, when compared to the general population, reports of delusional misidentification syndromes are extremely limited. The case of a 31 year old woman with mild learning disabilities and first episode of acute schizophrenia is described. She had both Capgras and Fregoli syndromes, and a rare variant of Capgras syndrome in which the misidentification was of a cat, rather than a significant person in her life. Aetiological factors are discussed.

A case of classical Koro is described, in a non-Chinese patient having all three symptoms of the syndrome. Of significance is that the patient has a very marked family history for psychotic and affective illness. Also prior to the illness the patient had been under considerable stress, due to his perceived lack of manliness in not providing for his child. The syndrome was associated with impotence, which has been noted as a frequent finding. Also the patient took active physical precautions to prevent further perceived penile retraction, as has been noted in Chinese affected patients.

Suicide pacts are rare in clinical psychiatric practice and usually one or more of the parties die. Here we present a case report where both parties survived. We point out similarities and differences between this pact and others described in the literature.

A case of traumatic encephalopathy from persistent and long-standing self-inflicted punches to the head is described in a patient with obsessive compulsive disorder. This rare complication is best seen as a mild form of ‘punch drunk syndrome’ in the light of the clinical, neuropsychological and radiological findings.

In Bipolar affective disorder, the importance of genetic factors is well established through family, twin and adoption studies. However the exact mode of inheritance is not yet known. Genetic studies using DNA linkage have been attempted to identify susceptibility genes. Linkage studies of chromosome 11 and X chromosome have proved to be inconclusive. Recent studies have focused on chromosome 18 and 21, although confirmatory findings are awaited. As such, determining which part of the genome needs to be studied remains a problem. One way of overcoming this is to look for ‘candidate’ genes, ie. genes for which a priori evidence exists that a susceptibility gene may be located nearby.

Such strategies have been used for example, trying to identify genes of interest by looking at association between chromosomal aberrations and bipolar affective disorder, and the study of co-segregation of certain diseases with affective disorder. More studies are needed to provide regions of interest. I would like to report three cases of bipolar affective disorder with a rare autoimmune disorder, cryptogenic fibrosing alveolitis.

Historically Western medicine has been divided into two main schools that were based on the ancient Greek tradition. These are the Hygeian school, based on the views of Hippocrates (born 460 BC), and the Asclepian school which is named after the Greek god of medicine but probably based on the physician Asclepius who was said to have performed miracles!

In brief, the Hygeian school of medicine views health as a natural state of the body. The body is believed to be endowed with inherent healing powers which, if one lives in harmony with these powers, maintains health and helps to restore it should it become impaired. Disease is seen as a manifestation of a weakness of the inherent healing powers of the body and the function of the physician is to help the patients to live within the natural law (vis medicatrix naturae) and to remove impediments to those mechanisms that maintain and restore health.

The second school that has profoundly influenced the development of modern medicine is the Asclepian school which arose in about 1200 BC around the teaching of Asclepius. This school focuses on diseases, their causes and cures. Each disease is considered to be the effect of, or response to, a specific cause that primarily affects a specific organ system. For every disease it is postulated that there is a specific drug or procedure which can alleviate the symptoms or cure the disease. Thus, the successful physician is the one who can make the correct diagnosis and prescribe the correct therapy.