A short overview of several saints, venerated in Christian tradition as protectors from headache, is offered as an introduction to a more substantial debate on the possibility and value of analysing historical literary and iconographic sources and their interpretation. Headache of possible psychosomatic origin allows (auto) suggestive therapy obtained by the invocation of saints to have had considerable success. This possibility favours the opinion that historical material can be useful not only for cultural-anthropological, but also for modern medical considerations as well.

Behavioural and interpersonal difficulties arising during the course of cognitive psychotherapy are common and they provide unique opportunities to assess and modify patients' beliefs and assumptions. A breakdown in the therapeutic relationship may be on a continuum from a simple misunderstanding to a more chronic and complex problem. It may act as a potent vehicle for change in the patient, but may also precipitate change in the therapist who is also part of that relationship which can influence treatment outcome.

Objectives: The aim of this study was to compare aspects of the quality of life of drug users on a methadone maintenance programme to drug users on a harm minimisation programme.

Method: Thirty-six clients attending the harm minimisation programme in the National Drug Treatment Centre, Dublin, were matched for age and sex to 36 clients on the methadone maintenance programme. All were interviewed with the SF-36 Health Survey Questionnaire to measure health related quality of life and with the Hospital Anxiety and Depression Scale (HADs) to measure psychological morbidity.

Results: More clients from the harm minimisation programme had previous psychiatric problems than clients on the methadone maintenance programme, with an odds ratio of 4.3 CI(1.2,15.2). On the HADs, clients on the methadone maintenance programme had significantly lower depression scores than clients on the harm minimisation programme. In addition more clients on the harm minimisation programme were severely depressed than clients on the methadone maintenance programme. On the UK SF-36 Scale, clients on the harm minimisation programme perceived a significantly greater deterioration in ‘change in health’ over the previous year than clients on the methadone maintenance programme.

Conclusions: Although clients on a methadone maintenance programme had an improved perception of their quality of life in relation to psychological and overall health function from the previous year, compared to clients on a harm minimisation programme, there still existed varying degrees of psychopathology in both groups which need to be considered when providing future services for drug users.

This overview of mental illness services in Ireland, North and South, over recent decades, is a descriptive account. It refers to policies, development and operation of the services, with certain figures relating to hospital admissions, human resources and costs in Northern Ireland and the Republic of Ireland. The paper points to the need for more detailed comparisons, which would require more rigorous, systematic health services research.

It is perhaps surprising that mental illness has such a limited role in the various works of James Joyce. When one considers the volume of material in his books relating to Dublin, topographical and biographical, there appears to be a studious avoidance of psychiatric institutions. The then huge Grangegorman complex (now St Brendan's Hospital) must have had an ominous presence in the city: the size of its population (between 1,500 and 2,000 patients) indicating that few families of whatever class could have escaped contact with it. Indeed, as an institution it probably had economic power comparable to Guinness's brewery or the British Army, which had five barracks in the city, each about the same size as Grange-gorman.

Objectives: Magnetic Resonance Imaging (MRI) has been used to assist the diagnosis of Alzheimer's Disease (AD) in adults with Down's syndrome (DS). However, the interpretation of the scans is difficult and clinical usefulness is uncertain. We aimed to summarise the current knowledge of MRI studies in adults with Down's syndrome with and without dementia and to discuss its implications for clinical practice.

Method: We identified MRI studies in DS by a computerised literature search with Medline, Embase, and Psychlit from 1986 to 2001. We examined the references of identified articles and hand searched relevant journals. Structural MRI studies were selected as this type of imaging is most frequently used in clinical practice.

Results: We included eight volumetric studies in adults with DS. Four of these included adults with DS and dementia. Overall, the size of brain structures such as cerebellum, hippocampus and cortex of adults with DS without dementia was significantly smaller than in normal controls. The basal ganglia were similar in size, and ventricles were enlarged. Furthermore, the size of brain structures in adults with DS and dementia was significantly different than in DS without dementia. In particular, ventricular and hippocampal volumes were affected.

Conclusions: The change in brain structure associated with dementia can be detected on MRI of adults with DS. However, these may be difficult to interpret given the extent to which brain appearance in DS differs from that in the general population. Implications for clinical practice and future research directions are discussed.

A case is described of female compulsive sexual behaviour in association with obsessive-compulsive disorder (OCD). This patient had non-paraphitic compulsive heterosexual multiple partner behaviour, which is a symptom complex previously termed nymphomania. There were also nonsexual obsessions, compulsions and avoidance behaviours diagnostic of obsessive-compulsive disorder. The case is presented for its clinical interest, because ‘nymphomania’ is rare, and because the patient presented with symptoms subtly different to others in the literature. The patient consented to her case being reported in the medical literature.

Koro is characterised as a perception that one's genital organs are shrinking and will eventually recede into the abdomen. It was initially described in South East Asia as a culture bound syndrome but this syndrome has recently been recognised in a non-culture bound context A case is described of a depressed Eastern European asylum seeker with koro like symptoms. All symptoms resolved completely with fluoxetine treatment The relevant literature to the case is reviewed, in relation to onset, symptoms and treatment of this rare syndrome. In addition comparison is made with previous reports of the non-culture bound variant.

A case of venlafaxine associated visual hallucinations is described. The underlying neurochemical pathophysiology is explored and recommendations for management of patients who experience this side effect are discussed.

We describe the case of a 30 year old Chinese woman who presented to an Irish psychiatric service with a five-month history of somatic delusions, auditory hallucinations and denial of lineage. We utilise this case to illustrate the significant cultural influences on psychopathology. We discuss the increasingly frequent diagnostic and therapeutic challenges presented by migrants with mental illness.

As colleagues in Ireland and England and Wales are bracing themselves for revisions of their respective mental health legislations, I would like to share some of the joys and tribulations of working within the legal framework of mental health of young people in England and Wales as it stands. (This is the first major reform of UK Mental Health legislation since the 1983 Mental Health Act, which was based on a full review of mental health legislation from the 1950s.)

On first approach, the complexities of this framework can be daunting. However the underlying principles are similar to Ireland's. Ideally, health professionals, parents and children are working together in a co-operative therapeutic alliance. In reality, factors such as time, communication, resources, differences in professional judgements regarding thresholds for concern and action, interagency and interprofessional rivalries impact greatly on our day-to-day practice.

We describe a lady with a history of recurrent psychotic depression, together with a persistent delusion of immortality, which appears to be independent of the depressive illness. It is of interest that this woman is a patient of the hospital founded by Dean Jonathan Swift, who described a people stricken with a similar dilemma of unhappy immortality over 200 years ago.