Serotonin aggregation is a measure of function of platelet 5-HT2 receptors. The test has been proposed as a valid peripheral model of central 5-HT2 receptor function. Receptors of this subtype are implicated in theories of the aetiology of depressive states.

This pilot study proposes a normal range for the test for both males and females. Untreated depressed subjects had results which grouped at the lower end of the range. The test proved reproducible with a correlation coefficient of r = 0.939 with an interval of at least six weeks between sampling. A small number of successfully treated patients were retested with no empirical difference in their results, which are included in the reproducibility studies.

Our provisional results indicate the reliability of serotonin aggregation scores for an individual. The difference in scores noted in depressed subjects is more likely to be a trait rather than a state marker.

Objective: The relationship between early adverse experience and psychological illness has been studied in younger adults, but not in the elderly. This study investigated early adverse experience in elderly women with a history of severe depression by using a semi-structured interview.

Method: Women admitted with a history of severe depression were identified and interviewed using the Brief Parenting Interview (BPI)(n=14).

Results: The majority of elderly women (71%) with a history of severe depression had suffered significant childhood trauma. Eight (57%) women reported parental loss, six (49%) reported tension or discord in the family home and one woman reported severe child sexual abuse. The majority of the women (87%) did not find the questionnaire distressing and all found it acceptable.

Conclusions: Considering the high prevalence of childhood trauma in this group and the problems treating severe depressive illness in the elderly, this area deserves further study. The BPI is well tolerated in elderly women with a history of depression.

Objective: Benzodiazepine misuse among opiate addicts is well described but few studies have reported on the occurrence and management of benzodiazepine dependence within this group. This study reports on the nature and extent of benzodiazepine dependence among a group of opiate addicts and describes the patients' treatment progress and requirement for substitute medication.

Method: Over a 12 month period routinely collected data on all admissions of opiate addicts to our inpatient treatment and research unit were searched. Specific details were then extracted for those 61 admissions who were opiate dependent and also currently misusing benzodiazepines.

Results: 26 (43%) of the 61 admissions were found to bephysically dependent on benzodiazepines. Temazepam and diazepam (respectively) were the most commonly misused preparations and 22% of those using temazepam were injecting it. Patients requiring detoxification were stabilised on doses of diazepam ranging from 20mg to 80mg daily (mean; 40mg). No correlation was found between reported use of benzodiazepines and the dose of diazepam required for stabilisation. Users found to be physically dependent on benzodiazepines more commonly reported daily use and use of two or more benzodiazepines concurrently.

Conclusions: Our findings suggest: 1) that benzodiazepine dependence occurs in opiate addicts with a frequency similar to that reported previously for other groups of benzodiazepine users; 2) that individuals using benzodiazepines on a daily basis may be more at risk of developing physical dependence; and 3) that clinically it is difficult to accurately predict requirements for substitute medication solely from patient's reported daily use prior to admission.

Objective: The aim of this study was to screen a group of medically ill elderly hospitalised patients for depression and to facilitate this using a new screening questionnaire called the Evans Liverpool Depression Rating Scale (ELDRS).

Method: The questionnaire was administered by a geriatric registrar to a consecutive series of 37 acutely ill elderly medical inpatients admitted to an acute hospital ward. They were subsequently interviewed by a member of the psychiatry of old age team.

Results: Seven of the 37 acutely ill elderly patients admitted to hospital were found to be suffering from a major depressive illness according to DSMIIIR criteria. Of the patients screened, two were already on antidepressant medication. Five of the depressed patients were identified by using the ELDRS. All of the depressed group were judged to require antidepressant medication and two were referred to a psychiatry of old age day hospital.

Conclusions: Our results suggest that there is a raised prevalence of depressive illness in elderly acutely ill medical patients which remains undetected. Use of a screening questionnaire such as the ELDRS would increase the likelihood of its identification in this group.

A 54 year old woman presenting to the psychiatric services with persecutory delusions, complex visual hallucinations and fluctuating levels of consciousness was discovered to have a meningioma occupying the cerebellopontine angle. The psychiatric symptomatology of cerebellopontine angle lesions is reviewed and the pathogenic mechanisms are explored in the light of the symptomatology observed.

Objectives: The closure of long-stay mental hospitals has led to more patients with psychoses being cared for in the community. Although surveys have been conducted in the London area, little is known about the attitudes of general practitioners in provincial parts of the United Kingdom towards schizophrenic patients and their care.

Methods: A questionnaire was sent to all general practitioners in the St Helens area in north-west England.

Results: 94 doctors replied, 53% of those circulated. Only a minority consider that such patients cause them a great deal of work. Problems with medication were cited most often as causing difficulties for the general practitioners. Psychiatrists were considered to be the group with whom the general practitioners had the best communication, but also where they wished communication to improve further. Despite the shift towards community care, there was no clear trend in the amount of work created by schizophrenic patients perceived here.

Conclusions: Only a minority of those doctors surveyed found that schizophrenic patients cause them an undue burden of work. Perhaps developments in community based psychiatric services should be directed first at those general practitioners who report excessive problems from patients with long-term mental health problems.

The suicide rate for county Kerry in 1988 was determined by clinical means using postmortem records as a starting point. Sixteen deaths due to suicide were thus identified (eight males and eight females). The official figure for the year is 19 (13 males and six females). Four of the clinically determined suicides did not appear in the official figures. Combining information from both sources gives a figure of 23 suicide deaths, a rate of 18.58 per 100,000. The authors conclude that there are continuing deficiencies in suicide recording practices.

Effectiveness of verapamil as a psychotropic and verapamil toxicity when used as a psychotropic are presented in this case study with literature review.

A case is described of an elderly man with secondary mania caused by neurosyphilis. This is thought to be the first such case in an elderly person. The implications for routine sero-testing are discussed.

Objective: The aim of this paper was to elucidate factors associated with inpatient suicide.

Method: A retrospective review of inpatient suicides over a 20 year period in the Cavan/Monaghan mental health service was undertaken. Clinical files, statutory reports and Central Statistics Office returns were studied and information was obtained on demography, diagnosis and circumstances of the event.

Results: Eight patients committed suicide, giving a rate of 0.55/1,000 discharges and 0.39/100,000 population per year. Depressive illness and Schizophrenia were the diagnoses found. Repeated admissions and long duration of illness were noted. Previous suicidal behaviour was common. Four of the patients were considered a suicide risk at some time during the index admission. Underreporting of the suicides and inaccurate registration of institutional location by the Central Statistics Office were found.

Conclusion: More formal clinical procedures in registering suicide risk are recommended. New procedures for investigating inpatient suicides are suggested. Largescale studies at a national level are essential in defining more specific and sensitive risk factors. Procedural changes involving accurate central registration of data are required.

Objective: To conduct an audit of the patients treated at a day hospital or in an inpatient unit of a district general hospital from the South Kildare sector of the Kildare Mental Health Service, a new community based psychiatric service.

Method: Retrospective case note review of all admissions over a six month period. ICD-9 diagnosis used.

Results: There were 39 and 29 admissions to the inpatient unit and day hospital respectively. The average duration of stay in the inpatient unit was 14 days, 66% were discharged home and 33% discharged to the day hospital. The average duration of stay was 30 days in the day hospital, 62% were discharged home and 17% discharged to the inpatient unit.

Conclusions: The trend was to treat more neurotic patients in the day hospital; psychotic patients were treated in both settings; the proportion of patients discharged home was similar. The duration of stay was longer in the day hospital.

Preoccupation with weight and shape is very prevalent in the female population and is generally well researched. However, the effects of eating psychopathology on infant growth and child development have not been adequately covered and they merit the attention and interest of clinicians. This present submission, using Medline search, critically reviews the available literature and highlights the importance of clinically addressing these issues. It also makes reference to other areas requiring further research. Fifteen articles are discussed which relate specifically to eating psychopathology and the possible effect on mother-child interactions.

Objectives: To examine the evidence concerning the recent developments in the genetics of schizophrenia.

Methods: An extensive literature search was performed and relevant papers were examined and analysed.

Findings: There is overwhelming evidence that schizophrenia shows familial aggregation. Recent molecular genetic studies support the presence of susceptibility genes on chromosomes 6 and 22. In addition, an association between schizophrenia, the dopamine D3 receptor gene and the 5-HT2a receptor gene has also been demonstrated.

Conclusions: Recent advances in DNA technology have paved the way for the detection of genes of major and minor effects in the aetiology of schizophrenia. If the presence of the recently identified susceptibility genes is confirmed, it is likely that these genes will be recognised in the near future.

Schizophrenia is thought to be the commonest setting in which delusional misidentification syndromes occur. Although schizophrenia is said to occur more commonly in people with learning disabilities, when compared to the general population, reports of delusional misidentification syndromes are extremely limited. The case of a 31 year old woman with mild learning disabilities and first episode of acute schizophrenia is described. She had both Capgras and Fregoli syndromes, and a rare variant of Capgras syndrome in which the misidentification was of a cat, rather than a significant person in her life. Aetiological factors are discussed.

We report on a patient with neurosyphilis with psychiatric manifestations. A point to notice in this case is the time elapsed (one year) between the first psychiatric contact and the final diagnosis. The case reported here suggests that neurosyphilis may have become a ‘forgotten disease’.

Objective: In view of the Royal College of Psychiatrists Defeat Depression campaign, to review the existing literature on depressive episodes in people with learning disabilities.

Methods: Review of all papers identified to cover this area. Papers were identified by Medline search and also by direct checking of the contents in the preceding five years of eight key learning disabilities journals, the British Journal of Psychiatry, Psychiatric Bulletin and bibliography in Current Opinions in Psychiatry. Papers about children or odd ‘depressive’ symptoms (rather than the syndrome of depression) were excluded.

Findings: For over a century it has been recognised that depression can occur in people with learning disabilities. However, the number of studies in this area is very limited. There remain many unanswered questions, such as those of prevalence, clinical presentation and diagnostic criteria, associated social factors, and the evaluation of treatments. Suitable rating scales have yet to be evaluated or devised. The authors propose diagnostic criteria for future use.

Conclusions: Research in this important area is very limited. Advances are yet to be made in the clinical assessment and management of the illness.

Objective: Genetic mapping, the method of comparing an inheritance pattern of a disease to that of a chromosomal region, has brought about a revolution in the field of human inherited diseases. Diseases which exhibit a more complex pattern of inheritance now afford the next challange in the application of genetic mapping to the field of human disease. This article aims to review the application of genetic mapping to affective disorders.

Method: Review of literature concerning the molecular genetics of affective disorders.

Findings: This article describes the evidence for a genetic role in affective disorders, reviews the research to date and describes the difficulties arising out of the complex nature of these disorders.

Conclusions: Although progress to date in psychiatric genetics has been somewhat disappointing, the combined approach of using all the genetic tools currently available on large collections of affected individuals and families should enable the genetic basis of affective disorders to be identified.

Objective: To quantify the number of patients absent without leave (AWOL) from an Irish psychiatric hospital in one year and to examine the clinical and demographic data of this group of patients.

Method: This was a retrospective study of all patients reported as AWOL from St Brendan's Hospital in 1991. The following information was obtained from the patients' case notes: age, sex, legal status, marital status, psychiatric diagnosis, number of previous admissions, past history of absconding, length and outcome of absence. Their clinical and demographic variables were compared with a control group of 214 patients (non-absconders) randomly selected from the hospital admissions over a 12 month period.

Results: A total of 48 patients absconded. The majority were male, single, compulsorily detained, with a past history of absconding. The most common psychiatric diagnoses were schizophrenia (32%), personality disorder (23%) and alcohol dependence syndrome (17%). While absent, three patients had a history of suicidal behaviour and four became involved in criminal activity. Compulsory status was statistically significant when compared to the control group.

Conclusion: The characteristics of our group of absconders are similar to those in previous studies apart from the increased prevalence of personality disorder and alcohol dependence syndrome. We discuss the risks associated with absconding and recommend close follow-up of this group of patients.

A case of classical Koro is described, in a non-Chinese patient having all three symptoms of the syndrome. Of significance is that the patient has a very marked family history for psychotic and affective illness. Also prior to the illness the patient had been under considerable stress, due to his perceived lack of manliness in not providing for his child. The syndrome was associated with impotence, which has been noted as a frequent finding. Also the patient took active physical precautions to prevent further perceived penile retraction, as has been noted in Chinese affected patients.

Doll phobia is a rare phobia that has only been reported twice in the literature, both times in male patients. The following case is the first to be described in a female patient. The characteristics of the dolls that caused most fear in all three cases are compared and the possibility that this indicates a similar genesis of the phobia that could be explored by psychodynamic psychotherapy is discussed. A Hellenic derivation of doll phobia for future use is suggested.