Objective: To assess the effect of specific psychoeducational sources – support group meetings, lectures and literature – on bipolar disorder patients' knowledge and attitude to their illness. Methods: Eighty bipolar disorder patients attending for a lithium blood test were asked to complete a questionnaire detailing their demographic characteristics, duration of illness, knowledge of manic-depressive illness and their attitude towards their illness and what exposure they had had to relevant support group meetings, lectures and literature on bipolar disorder. Results: The 43 group attenders had a statistically significant higher mean score on the illness and lithium knowledge and the attitude to illness sections of the questionnaire than the 30 patients who did nto attend groups (P<0.001). A multiple regression analysis indicated that, in addition to group attendances, only reading literature contributed significantly to illness knowledge and attitude. Age, sex, duration of illness and socio-economic status did not contribute significantly to these outcome variables. Conclusions: Bipolar disorder patients who attended support group meetings and availed of relevant literature knew more about their illness and lithium therapy and expressed more positive and realistic views about their illness than those who only read literature and attended lectures.

Objective: This survey attempts to ascertain the attitude of the general public towards the mentally ill and former psychiatric patients in Ireland. Method: A random selection of 155 adults were interviewed using Likert-type scales (29 items). Results: Factor analysis revealed four main attitude dimensions: fear, lack of sympathy, personal rejection and perceived community rejection. Overall, respondents express a low level of fear and a high level of sympathy towards the mentally ill. Lack of sympathy correlated highly with older age group, lower educational level and lower socio-economic class of respondent. Respondents with higher self-reported knowledge about mental illness were less fearful and more sympathetic towards the mentally ill. Conclusions: The findings are encouraging to the development of community psychiatric services and support the usefulness of public education in the area of mental health.

Objective: The Objective of this study was to analyse the characteristics and disabilities of patients becoming new longstay in a Mental Health District, to describe their needs and define the implications for service development. Method: All patients entering into the new longstay category between January 1st 1981 and December 31st 1991 were analysed. New longstay patients were defined as those remaining continuously in hospital for one year or longer. An accumulated inpatient group, still resident in the hospital, was examined using the Community Placement Questionnaire (CPQ), a standardised questionnaire useful for estimating needs for care and accommodation. Results: The analysis revealed a globally disabled patient group, largely intractable to treatment, the majority of whom required care and supervision in the longterm. An estimate of new longstay bed requirements, based on a stay of 1-5 years, was 11.3 per 100,000 for those under 65. The assessment team categorised current inpatients into four groups with regard to placement recommendations. An analysis of the CPQ results supported these recommendations which were: Specialist Unit for chronically disturbed Geriatrics, Geriatric Unit, High Support Staffed Hostel and Medium Support Staffed Hostel. Conclusions: Despite current service practice and community provision new longstay patients continue to accumulate. Given further specialist alternative community structures, it is suggested that these patient's requirements can be met without the need for continued longstay mental hospital beds.

A case is presented of multiple tooth autoextraction performed by a 22 year old male known to be afflicted with the Gilles de la Tourette syndrome.

This unusual and rarely reported aspect of the syndrome caused initial diagnostic confusion and improved following psychiatric therapy.

A case of the Fregoli syndrome in a patient meeting the DSM-III-R criteria for Cannabis Delusional Disorder is presented. It appears to the authors, after reviewing the literature on the subject, that the delusion ascribed to the Fregoli syndrome, which occurs mainly in Schizophrenia, is being noted in a slowly widening group of psychotic disorders, of which Cannabis Delusional Disorder is the latest.

A 61 year old man presented to the psychiatric services with an eight month history of musical hallucinations, unresponsive to neuroleptic medication. Investigation revealed hypertension with brain infarcts in the left temporal and left parietal lobes. Following reassurance that his hallucinations were organic rather than psychiatric in origin, they faded in significance.

Urinary incontinence commonly occurs in the setting of organic brain damage. However a literature search found no previous reports of an association between urinary incontinence and functional psychosis. Three cases are described in which patients with organic predisposing factors for the development of urinary incontinence showed an association between the degree of incontinence and the severity of their mental illness. It is suggested that the underlying psychosis may have contributed to the worsening of urinary incontinence, perhaps through non-specific factors such as poor attention, memory and psychotic symptoms. An association between functional psychosis and urinary incontinence has not been previously reported, and thus merits further investigation.

Objective: Recommendations for the sensitive management of perinatal and late pregnancy deaths are now widely applied. This study assessed management experiences and preferences of women who had an early miscarriage to ascertain if current practices are acceptable to these women. Method: Women who had experienced a first trimester miscarriage in the previous year and had attended hospital were identified from hospital and GP records. They were interviewed using a semi-structural format (N=27) and asked about their own experiences and opinions regarding viewing the foetus following miscarriage and making burial arrangements. Results: Most women did not see their miscarried foetus (85%) or know what burial arrangements had been made for the foetus (92%). Preferences regarding these issues were varied but all women felt that parents should be consulted. Conclusions: Recommendations on specific arrangements for the viewing of and disposal of remains following early miscarriage may be secondary to the provision of choice for the parents involved.

A patient with epilepsy developed panic and agoraphobia. A large right temporo-parietal, arteriovenous malformation was detected. The relationship between these disorders is discussed.

Objective: Various studies have shown an association between ABO blood groups and both physical and mental illness. This pilot study was conducted to find out whether there is any association between ABO blood groups and senile dementia of Alzheimer's type. Methods: The sample was selected from 107 patients admitted to the psychogeriatric assessment unit of the district psychiatric hospital over a period of one year. All Caucasian patients of United Kingdom origin above the age of 70 with confirmed diagnosis of Alzheimer's dementia according to DSM-III criteria who had developed dementia after the age of 65 were included (N = 33); 74 patients were excluded for various reasons. Results: Out of the 33 patients there were 21 (64%) with group A, 3 (9%) with group B, 9 (27%) with group O and none with group AB blood. Among the United Kingdom population there were 79,334 (42%) with group A, 16,280 (9%) with group B, 88,782 (47%) with group O and 5,781 (3%) with group AB blood (p = 0.038). Conclusions: Although the number of cases were not large, the results of this study suggest that the prevalence of type A blood group was greater and O was less for Caucasian Alzheimer's subjects than for the general population.

Increasing exposure to video technology has provoked descriptions of psychopathology related to playing video games. However, there exists no description of hallucinatory phenomena occuring in psychotic illness deriving from such material. The subject of this report is one such patient suffering from a persistent auditory hallucination of computer music and other non-verbal information.

A sixty three year old woman developed an organic psychosis after stopping lorazepam. She had taken a high dosage of the drug for 4 years but had discontinued it gradually in reducing doses over six months. It suggests that serious withdrawal reactions may still occur despite gradual cessation and highlights the importance of total dose ingested as a predictor of withdrawal phenomena.

The evolution of the serial killer in cinematic portrayal is described and examined in terms of its representation of the archetype of the shadow.

Legislation governing committal practice has been a cause of controversy worldwide. A review of the relevant literature highlights the ongoing debate between those advocating broadly based ‘need for treatment’ criteria as a basis for committal (‘Parens Patriae’), and those who advocate more narrowly defined criteria requiring evidence of ‘dangerousness’ to validate committal. Current committal law in Ireland follows the ‘Parens Patriae’ tradition. However the recently published Green Paper on Mental Health points out that the current law is not compatible with international obligations, making reform inevitable. The Green Paper suggests various alterations in relation to committal criteria and procedures, with the retention of both ‘need for treatment’ as well as ‘dangerousness’ as valid committal criteria. These changes appear to be compatible with the ‘Stone criteria’ adopted as a model committal law by the American Psychiatric Association.

Objective: Exegetic review of the three areas of common interest to the endocrinologist and the psychiatrist. Method: Literature review through Science Citation Index and references in BMJ, Lancet, Nature, and Science. Findings: Psychiatric symptoms, specific in each condition, may develop in the course of a classical endocrinopathy. Though introduced as a possible diagnostic aid, titration of the hypothalamico-pituitary control of the adrenal and thyroid glands has proved to be a useful research strategy and possible prognostic indicator in affective disorders. Growth in our knowledge of the behaviour effects, distribution, function and pathophysiology of neuropeptides during the last two decades opens a magic casement on their potential value in neuropsychiatric theory and therapy. Conclusion: The psychiatrist ignores endocrinology at his peril, as does the endocrinologist psychiatry, especially in regard to the emerging role of peptides in neuromodulation.

Objectives: To examine the reasons why manic-depressive patients often fail to respond to lithium and, the chief purpose of this paper, to review the present state of knowledge concerning alternative pharmacotherapies to lithium in this disorder. Method: Literature review. Findings: Lithium produces a clinically useful effect in 70-80% of cases. Factors such as non-compliance, side-effects, serum levels, and enduring psychosocial influences on the patient must be considered before treatment failure is diagnosed. Carbamazepine is the most studied alternative drug to date, and the most likely predictors of response to this agent are rapid-cycling, absence of a family history of affective disorder, mania, severe illness, and non-response to lithium. Conclusions: In view of the 20-25% of patients who do not respond to lithium, and the increased likelihood that lithium-responders may fail to respond again once the drug has been stopped for a period, further research is needed to find better and safer prophylactics against depression in bipolar disorders and to refine our knowledge of the indications for use of those already available.

Objective: of the review was to explore the three major controversies over the controlled drinking debate, and to assess for whom controlled drinking may be a viable form of treatment of alcohol dependence. Method: was to survey the literature of the last twenty years, using the Medline data base, the Index Medicus, and the Excerpta Medica. Findings: were that controversies involving the work of the Sobells and the Rand reports were influenced by the social attitudes of the time, and that D.L. Davies work despite being methodologically unsound, made the consideration of having a controlled drinking goal a viable treatment option. We also found that comparing studies using different definitions of controlled/normal drinking is difficult, but it would appear that the young, married, less severely dependent, and possibly female drinker may benefit from this form of treatment. The return of a patient to controlled drinking is not always dependent on the treatment model they have undergone. Conclusions: are that controlled drinking should be considered as a serious option, and that the recommended safe alcohol intake, will differ between patients, and that flexibility will be required. Also that a source of ongoing collateral information about the patient is essential.