Objective: To ascertain the views of Irish GPs with regard to local child psychiatry provision.

Method: 180 randomly selected general practitioners were sent a questionnaire designed to ascertain their views on child psychiatry services. They were asked to rate service provisions, professional staff and therapies offered in terms of priority.

Results: 74 (41%) returned completed questionnaires. Written reports, short waiting list times and emergency inpatient provisions were accorded the highest priority by the largest number of GPs (77%, 64.9%, and 63.5% respectively). Expertise in child sexual abuse, mental handicap and alcohol/drug addiction were also prioritised (77%, 66.2%, & 58.1% respectively). The core staffing required included child psychiatrists, community psychiatry nurses, psychologists and social workers. Family therapy followed by counselling were the most popular treatment modalities. However, more than two thirds (68.6%) of the sample rated their current service as unsatisfactory.

Conclusion: In planning service provision it is important to take into account the needs of the community, referrers' views and accessibility in order to provide optimum services for both users and referrers.

Objective: To determine whether the previously reported relationship between menstruation and emergency psychiatric admissions still pertains.

Method: All females admitted on an emergency basis to a general psychiatric unit of a DGH, were interviewed and data regarding menstrual function was collected on those fitting the inclusion criteria who consented to inclusion in the study.

Results: Ninety three people were included in the study, of whom significantly more were admitted in the late luteal and menstrual phases of the cycle. Symptoms suggestive of premenstrual syndrome were significantly commoner in those admitted in the late luteal and menstrual phases.

Conclusions: The findings suggest that the premenstrual syndrome is either a risk factor for psychiatric admission or is important in determining the time of admission. Adequate detection and treatment of premenstrual syndrome, could in theory, reduce some psychiatric admissions. The methodology and limitations of the study are discussed.

Objective: With the increasing demand for clinical psychology services and the existing shortage of clinical psychologists, it is theoretically and clinically important to identify variables associated with non-attendance for clinical psychology appointments. The study reported here attempted to: (a) examine the effect of waiting time for an appointment on non-attendance to clinical psychology services; (b) investigate variables associated with prolonged waiting time; (c) explore the nature of the relationship between waiting time and length of psychological treatment.

Method: The records of 49 3 patients offered an appointment to attend a clinical psychology service over a period of 24 months were analysed. Subsequently information on sex, age, type of referring problem, previous treatment history, treatment venue and waiting time for appointment, was collected and statistically analysed.

Results: Non-attendance was significantly related to prolonged waiting time and young age. Controlling for the effects of waiting time and age, patients with complex problems and new patients wh o had never sought psychological treatment in the past were less likely to attend. Length of waiting time was higher in groups with previous treatment history, patients seen at a hospital based department, and patients with complex problems and anxiety disorders. Finally, length of psychological treatment (total number of sessions required) was not affected by prolonged waiting time.

Conclusion: Non-attendance for clinical psychology appointments was associated with (a) young age, (b) prolonged waiting time (over six months), (c) complex psychological problems, and (d) new patients. The limitations and clinical implications of these findings are critically discussed.

Objective: To explore the nature of the relationship between the Greysteel massacre and the low number of admissions with overdose to the area general hospital in the following week.

Method: Ward records over a ten year period were examined for seasonal and yearly trends for admission with overdose.

Results: In the two year period surrounding the week following the Greysteel massacre there were no similar periods of low admission with overdose.

Conclusion: A direct relationship between the Greysteel massacre and the ensuing dearth of admissions with overdose seems likely.

Objective: Community organisations provide care for psychiatric patients at multiple levels. With increasing emphasis on joint planning and purchasing of care it is important to ascertain the views of such organisations towards statutory organisations and services the latter provide.

Method: All community organisations working within one inner city catchment area in London were approached in order to obtain their views and experiences on the mental health services provided by the secondary care services. This was a postal survey and non-responders were contacted by personal calls.

Results: Sixty organisations out of a total of 100 in the database responded. More than half had experiences of statutory services and these were generally negative. The services provided were perceived as being rigid and inflexible. A large majority of the organisations wished services to be more flexible as well as provide more training for voluntary organisations.

Conclusion: The survey suggests that the perceptions of the statutory services and co-working with voluntary organisations can succeed only if the two groups work together closely to make good quality community care possible.

Many Irish graduates chose to pursue specialist psychiatric training in Britain. Regulations governing UK specialist training are currently changing in response to European Union (EU) directives. Furthermore, over the past five years the UK national health service has undergone significant reforms. This paper reviews the current status of British postgraduate training and examines the options for Irish doctors who take this route to a career in psychiatry.

Residency training in psychiatry in America is an option which has been little explored by Irish psychiatric trainees, although one which is readily available to them. This article attempts to illustrate this option by providing a brief outline of residency training, and by comparing this with psychiatric training in Ireland or the UK.

Objective: To measure the effects of providing a therapeutic community environment for patients suffering from severe mental illness.

Method: 35 patients who remained in a therapeutic community environment for a minimum of 18 months were administered three instruments which measured psychiatric symptomatology (Brief Psychiatric Rating Scale), intrapsychic and interpersonal functioning (Therapeutic Community Questionnaire) and overall psychiatric and psychological functioning (Global Assessment Scale). Assessments were carried out at zero and 18 months.

Results: The Brief Psychiatric Rating Scale revealed significant positive changes on the two items of blunted affect and un-cooperativeness while the global assessment scale revealed that patients significantly improved after 18 months.

Conclusion: Patients who remained in a therapeutic community environment for 18 months demonstrated benefits on three particular variables. While no causative link can be proposed in this study, it does seem that this environment does improve the functioning of severely mentally ill patients.

Objective: The objective of this audit to examine the effect of risperidone therapy in controlling some behavioural disturbances in people with learning disability.

Method: Retrospective analysis of various behavioural disturbances before and after beginning risperidone therapy (during the month before risperidone was started in each case, and during September 1994 in all cases).

Results: Risperidone was found to be effective in controlling various behaviour problems in 12 of 17 patients.

Conclusion: Risperidone may selectively influence behaviour problems secondary to possible underlying mental illness but not others. There was also some evidence that it was more effective in an average dose of 6-8mg/day, but was not beneficial in doses smaller or larger than this dose range.

Single photon emission tomography (SPECT) is the prototypical tool for measuring cerebral blood flow (CBF) in discrete areas of the brain. Compared with when a male ‘crack’ cocaine user received placebo, oral cocaine (1mg/kg) ingestion was associated with non-uniformity of overall CBF with hypoperfusion of discrete brain regions, particularly of the frontal, temporo-parietal, basal ganglia, and thalamic areas. While these results should be viewed as preliminary, they do suggest that oral cocaine use may be associated with CBF abnormalities in ‘crack’ users.

Patients with Parkinson's disease are frequently treated by psychiatrists. We report on the exacerbation of parkinsonian symptoms in tw o patients prescribed paroxetine, an SSRI antidepressant. We discuss the possible mechanism for such an interaction.

A case is described in which a man with asthma and a history of alcohol dependence presented with a paranoid psychosis refractory to standard neuroleptic treatment. Symptomatic improvement was achieved when abuse of salbutamol (Ventolin®) metered dose inhaler was discovered and an alternative β2-agonist delivery system prescribed. A contribution by salbutamol to the psychosis is proposed. It is suggested that increased awareness regarding psychiatric morbidity is needed when metered dose salbutamol inhalers are prescribed.