The effects of a series of 6 ECT treatments were observed on the CSF concentrations of neurotensin and substance-P in eight patients suffering from schizophrenia. Four patients were previously drug free. No significant effects of ECT were observed.

In an Irish general hospital 82 admissions were given the MAST questionnaire and 331 patients were given the CAGE questionnaire for alcoholism. Of those who were given the CAGE 67 scored 1.0 or more, (maximum socre: 4.0), and 36 scored 2.0 or more, denoting a prevalence of probable alcoholism in this population of 11%.

Of those scoring 3.0 or 4.0 on the CAGE, 38% of males and 100% of females claimed to have abstained from alcohol for at least one year and 54% and 100% respectively had a heavily drinking relative.

Twenty-three per cent of patients tested with the CAGE and MAST questionnaires claimed never to have drunk alcohol.

The number of patients diagnosed in the medical charts as having an alcohol problem was fewer than those detected by the CAGE questionnaire. It is suggested that the CAGE questionnaire may be a simple and efficient way of detecting excess alcohol consumption in a general hospital population.

An account is given of an approach to group therapy for stuttering using Kelly's personal construct theory as a basis for exploring the understanding of stuttering and the process of change. All five clients who participated showed considerable improvement in fluency on the Riley Stuttering Severity Instrument. Although the improvement may be due to concurrent individual fluency therapy, feedback on the group sessions suggested that group therapy had a positive effect on personal behaviour and facilitated transfer and maintenance of speech fluency.

We report a case of the Capgras Syndrome in a 67 year old woman who was found to have a glioma of the left frontal lobe. Our case illustrates the multiplicity of possible aetiological factors which frequently coexist in this condition and make any assessment of possible pathogenetic mechanisms difficult. However, there appears to be a consensus of recent neuro-imaging studies that frontal lobe pathology may be important. The possible relevance of this is discussed together with a suggestion for further elucidation of the origin of the delusion.

A case of unilateral auditory hallucinations with endogenous depression is described. Treatment of depression improved the hallucinations. The relationship of lateralisation phenomena with cerebral hemispheric dys-function and peripheral ear disease is discussed.

A group of psychiatric nurses (N = 15) rated the impact of participation in a one year post-experience training course in behavioural psychotherapy on their personal/family life; professional practice; and professional relationships. Levels of stress associated with different phases of the course were also monitored.

Results indicated that the main stresses were associated with re-adjustment of family life over the period of the course and ensuring stability of training placements at the outset of the course. The course fulfilled participants' expectations with regard to improving their clinical practice, and confirmed their view that relationships with psychiatrist colleagues would be unaffected by their participation on the course. Impact on relationships with nurse colleagues was more positive than had been anticipated during the period of the course.

The reception of family therapy into a psychiatric profession that during the 50s was inclined to sanctify the individual psyche rather than the system inevitably polarized the profession. Psychiatrists contribute a significant referral imput to family therapy services in public health settings and therefore their knowledge of and disposition towards family therapy are influential elements of the context within which family therapy is practised, (i) This paper, through the use of a questionnaire, addresses qualitatively the prevailing attitudes and conceptualizations of psychiatrists working in the Eastern Health Board, Ireland, regarding family therapy, (ii) It looks at these opinions in the context of recent research findings on the efficacy of family therapy and highlights a famine of concise information regarding specific family treatment modalities, (iii) Finally it looks at the difficult relationship that exists between the old and the new epistemologies, which may be termed the ‘conservative and the impetuous’, and the implications for legitimate research into family therapy in the context of a consumerist-driven health service and at the interface of conflicting ideologies.

We present a case of the Charles Bonnet syndrome the onset of which appears to have been associated with vascular pathology. The syndrome typically involves the appearance of mute, colourful and pleasing visual images with the retention of insight into their hallucinatory nature. However, the case progressed in a very atypical way and a system of paranoid delusions developed around the visual hallucinations. The syndrome is reviewed and the possible reasons for the atypical course discussed.

Hepatic encephalopathy is a neuropsychiatric disorder usually associated with severe hepatic insufficiency. It may however be divided into clinical and subclinical groupings. Psychometric testing, serial EEG's, EEG spectral analysis and event related potentials are all presently being used to quantify and differentiate between the various stages of hepatic encephalopathy. We review the use of psychometrics in hepatic encephalopathy and discuss evidence that these findings are comparable with the more objective data of electrophysiological studies. An adequate, simple and inexpensive assessment may be carried out using a battery of psychometric tests which include number connection tests and five pointed star construction.

Interest in the process of reminiscence has increased in recent years. This article reviews changing attitudes to reminiscence and the various theories as to its function. Some clinical applications are discussed, in particular its potential therapeutic value in dementia.

We present a descriptive study discussing the reasons why patients remained as in-patients within the psychiatric unit over the Christmas period. In over 50% of cases continuation of in-patient stay was necessitated by the severity of mental illness. However, a significant minority of patients were unable to leave because of either poor family support or reduced input from the community mental health services. There was some evidence of Christmas good will influencing admission policy with a significantly greater number of patients admitted with alcohol problems over the week before Christmas all of whom were lonely and expressed a preference to be in hospital.

A more long term problem was also evident as an important minority of patients' hospital stay was unnecessarily prolonged because of unavailability of suitable community placements.

A significant minority of cases of Huntington's disease commence before the age of 20 years and these juvenile cases are more likely to demonstrate paternal transmission and a clinical picture dominated by rigidity. Genetic research and positron emission tomography may make early diagnosis easier but predictive testing in childhood is replete with serious problems. There is no specific treatment for this fatal disorder. Juvenile Huntington's disease has a similar pathology and biochemistry to the adult condition despite a shorter course and certain clinical differences, such as rigidity and convulsions. Racial differences are explored.

A number of psychiatric syndromes are characterised by the conscious or unconscious production of factitious symptoms. These include Munchausen Syndrome, the Ganser Syndrome and malingering. Here we describe a patient who rapidly changed her symptomatology according to material from her environment. Her presentation does not meet criteria for any of the above syndromes, but is best described as a factitious disorder (DSM-III-R). This case provides a framework for discussion of the validity of this concept.

Anxiety states comprise three components, the subjective, the physiological and the behavioural. Anxiety disorders differ from normal anxiety in that cognitive clues inducing the emotion are covert. Anxiety can be induced by a variety of chemical agents, including the catecholamines, caffeine, lactate and some beta-carbolines. Models can be built up from the standpoints of Schachter, Lader and Matthews, and Clark to provide a cohesive theoretical framework for anxiety and panic disorders. Both pharmacological and psychological treatments are effective in these conditions and the model can incorporate the mode of action of these therapies. The ultimate goal is a holistic concept of anxiety combining the bio-psycho-social approaches.

A case of chronic disulfiram (Antabuse) toxicity is described, in the context of a literature review, apparently the first such description from Ireland. The rare combination of encephalopathy with peripheral neuropathy occurred in this case, along with other probably related features. These included a fluctuating clinical course, cerebellar ataxia, grand mal seizures, impotence and a delay in improvement on discontinuing disulfiram. It is likely that symptoms of anxiety and depression in this man were also in part induced by disulfiram toxicity, but interpretation of events is complicated by developing arteriosclerosis. The difficulties in distinguishing toxic effects of disulfiram from complications of chronic alcoholism are emphasized, with resulting delay in recognizing disulfiram toxicity.

Lithium treatment, employed in western countries by 1 – 1.5 persons out of every 1,000 in the population, might with advantage be used more for mania and as a supplement to antidepressants in treatment refractory depressions. Prophylactic efficacy is as good in unipolar depressive as in bipolar illness. Start and discontinuation of prophylactic treatment is decided jointly by patient, spouse and psychiatrist. Treatment intensity (dosage, serum level) should be fine-tuned to lowest effective level. Treatment safety is ensured by observation of guidelines and precautions, and again cooperation between the psychiatrist and the carefully instructed patient and family is essential.