A case of inappropriate ADH secretion, water intoxication, convulsion and unconsciousness occurring during abrupt withdrawal of benzodiazepines due to the patient under reporting her consumption is described.

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 case of a lady who developed a major depressive illness with secondary pathological gambling is described. The gambling was manifest by uncontrolled purchasing of lottery tickets. The inter-relationship between affective disorder and pathological gambling and the effect, if any, of lotteries on pathological gambling is discussed.

Three cases of schizophrenia (DSM-III-R) (l), whilst responding to treatment, exhibit a group of symptoms which had the essential features of “flashbacks”, as described in relation to psychedelic drugs, though there was no evidence of psychedelic drug misuse. Symptoms were characterised by memory flashes of the original psychotic experience, followed immediately by very brief re-experiencing of earlier symptoms, including visual perceptual changes in clear consciousness and full insight. Symptoms were less clear, less severe, but more distressing, than the original episodes. Symptoms were triggered by stress/anxiety, and relieved by an anxiolytic. The association of flashbacks with schizophrenia is discussed.

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

A case of Koro or the Genital Retraction Syndrome in a young man where the symptom of Koro was secondary to a Major Depressive Disorder is reported here. This is the first such case to be reported from Ireland.

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.

Modern methods of investigation in conscious subjects have shown that in normal brain, language is catered for by several essential areas localised in the frontal and temperoparietal cortex and by widely dispersed neurones that serve subsidiary, specialised linguistic functions. These sensory specific, phonological, articulatory and semantic ‘modules’ are activated in parallel. A relatively limited amount of language heard during the sensitive period, when one or other cerebral hemisphere usually becomes dominant for language, is all that is required for any normal child to develop fluency. The specific details of the code, or ‘set’, developed are dependent on the language of the child's environment; they are culturally acquired, but the propensity for language is inborn. During this sensitive period, two languages may be as easily accommodated as one. In stark contrast to the acquisition of natural bilingualism, after about the age of 10 years, any new language is acquired with difficulty for it must be translated into the individual's established language or languages. If a nation is to become bilingual, full advantage of the evanescent sensitive period must be taken by regularly exposing the pre-school child, rather than the older child undergoing formal education, to two languages.

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.

Objective: The authors were aware of a high level of aggression in their centre and felt that a systematic review of incidents of aggression could be of benefit to both staff and residents. Method: A retrospective review of all incidents over a one year period was performed. Data involving the resident and the incident itself were analysed. An ICD 9 psychiatric diagnosis was attributed to each resident where possible. Results: The results show a large number of incidents, mostly of a minor nature. In almost half the incidents the nurse was the victim. There was a lower number of incidents in January and February. Forty one of the 45 residents involved in incidents had a psychiatric diagnosis. Conclusion: There is a general trend for moving from residential settings to the community. Our results suggest that as time goes on our centre will contain more residents with a psychiatric diagnosis who have a potential for aggression. We suggest ways of coping with this aggression and produce an incident form for recording aggressive incidents.

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.