Objective: Anxiety management techniques may all be expected to produce immediate therapeutic effect; more information is required on long term outcome after contact with the therapist ceases. The study is an independently monitored enquiry into the outcome of a brief technique, Anxiety Control Training. Following eight ten-minute instructional sessions with the therapist, assessments were made by a person who had not been involved with the treatment. Medication was withheld throughout the whole period of the study and ‘booster’ sessions were not given in order that an estimate may be made of the degree of subsequent improvement which may be attributed to the patient's own resources and continued practice of the technique. Method: The study was conducted on a sample of patients referred to an anxiety management service suffering from a phobic disorder. Assessments of the severity of the phobia and of generalized anxiety were made at commencement of treatment, at the end of the eight sessions and thereafter at three month and nine month intervals. Follow up assessment of all patients included in the sample was achieved. Results: At inception into the treatment phase seven of the 22 patients suffered from a moderate to severe degree of generalized anxiety in addition to phobia. As expected a significant (p<0.001) degree of improvement in phobic severity occurred during the period of therapy. Following termination of therapy further significant (p<0.01) improvement occurred up to the final assessment. The number of patients suffering from generalized anxiety was too small to allow confident conclusion but the results suggest improvement in generalized as well as phobic anxiety. Conclusions: The instructional sessions of the ACT procedure provide skill in mastery over anxiety. The subject may continue to use this skill without further aid from the therapist; with regular practice of the technique progressive improvement is likely to occur.

Two individuals, a father and son with idiopathic intestinal pseudo-obstruction (IIPO), a familial visceral neuropathy, and major depressive illness are presented. In both the bowel symptoms preceded the onset of the depressive illness – the bowel symptoms presenting in mid-adolescence and the depressive illness presenting in middle age. Both patients required numerous laparotomies and both were treated with a series of ECTs. Both developed vitamin B12 deficiency anaemia and other evidence of malabsorption. At post-mortem both patients showed evidence of distension of the small bowel with volvulus. An extensive pedigree of both conditions overlapping in two inter-related families now extending to the fourth generation with 28 children under the age of 30 is described. Pending further investigation and genetic studies we postulate a possible common neurotransmitter pathology and recommend further neurochemical and histopathological studies of the myenteric plexus in IIPO. Furthermore, the genetic locus of familial IIPO might provide a genetic marker for some forms of primary affective disorder.

Post traumatic stress disorder (PTSD) is a well recognised condition which occurs in people who have been exposed to severe trauma as victims, potential victims or witnesses. A review of case notes of all prisoners transferred since 1988 to a national forensic psychiatric hospital following traumatic hanging events in prison revealed that all patients had psychological symptoms and four had symptoms probably fulfilling PTSD according to DSM III R criteria. Our findings are discussed with reference to the literature on PTSD, the nature of the prison environment, the premorbid personality of prisoners, and the implications for dealing with the effect of suicide within a prison setting.

Three children who experienced hallucinations in two single-parent families are described. The children's symptoms subsided when the families were treated using a family therapy approach. This report highlights the need for mental health professionals to be aware of the possible response of children to parental psychopathology.

We report a Klinefelter male who presents requesting gender reassignment surgery. There may be a predisposition to gender dysphoria in Klinefelter's Syndrome, and in the case we describe, the perception of his symptoms as being of biological origin coupled with the unavailability of gender reassignment surgery in the Republic of Ireland has had a negative therapeutic effect.

The occurrence of neuroleptic malignant syndrome in two sisters is described. The possibility of there being any genetic predisposition to develop the syndrome is raised.

Command hallucinations have been implicated in some cases of physical assault by patients with schizophrenia. This paper is, to our knowledge, the first in the literature to describe sexual assault and this form of psychopathology.

A brief series of four young male patients with schizophrenia who attempted and, in one case, succeeded in sexually assaulting young women as a direct response to command type or imperative auditory hallucinations is described.

All four patients had limited or no sexual experience prior to the incidents described and their illness has attacked them at their “psychological Achilles heel”.

All four had lengthy in-patient admissions and proved quite resistant to conventional treatments.

We would suggest that command hallucinations need to be taken very seriously: some patients do as their voices command.

Objective -To examine the safety and efficacy of alprazolam as an outpatient detoxification agent. Mehtod - Two-year, prospective, uncontrolled study of detoxification from alcohol employing alprazolam in a North Wicklow day centre. The HAD scale was used to measure emotional change. Results -Detoxification was completed in 26 cases. Adverse effects were mild or absent. Significant changes were recorded in both HAD scale scores. Client and staff satisfaction ratings were both high. Conclusions - Alprazolam is a safe and effective detoxification agent in outpatients. The HAD scale provided an objective measure of changes in anxiety and depression in this group of alcoholics. The treated population were older and more often employed than were alcoholics treated in the parent psychiatric hospital.

The authors summarize a case wherein trazodone was utilized to maintain therapeutic seizure duration during electroconvulsive therapy (ECT) and review the literature in detail (36 references).

Objective: To determine the level of engagement as defined by return for out-patient appointment in patients referred for alcohol counselling in a general hospital. Method: The hospital was offered a service with counselling within 24 hours for patients who were identified by ward staff as having alcohol related problems. Referred patients were interviewed on the ward by a nurse who specialised in alcohol counselling. Follow-up appointments were offered. Results: 60% of those given counselling returned for further counselling as out-patients. 83% of women counselled were engaged compared with 42% of men (p<0.05). The mean SADD (a measure of alcohol dependency) score was 23.9 in those subjects who were engaged and 18.6 in those not engaged (p<0.05), indicating greater dependency in the former group. Conclusions: Although these patients had not actively sought help with their drinking 60% returned for counselling as out-patients. Women and those with high levels of alcohol dependency were more likely to seek further counselling.

The content of delusions can reflect recent changes or developments within the environment.

We describe three cases which illustrate, to our knowledge for the first time, the incorporation of Satellite Television Dishes within the experience of psychosis.

Objective: Psychiatric units in general hospitals are becoming a key feature of Irish psychiatric practice. This is in accordance with national policy as laid down in “Planning for the Future” in 1984. To date these units have not been the subject of much research. This paper presents baseline data, gives some clinical impressions of how these units are operating, and discusses the implications of these findings. Method: Questionnaires were sent to the medical directors of all 12 psychiatric units in general hospitals in Ireland. In addition, statistical data was collected from the Health Research Board and from the Mental Health Services Section of the Department of Health. Results: All the questionnaires were returned and the results showed that these units were operating in a largely self sufficient way with little usage of local psychiatric hospitals. Outside Dublin 35% of all Health Board admissions are now going to such units, a figure comparable to England and Wales. There was little evidence of patient selectivity as units seemed to be treating the full range of psychiatric disorders. Conclusion: The picture given of general hospital units in Ireland is, in the main, very encouraging. The main problems encountered were the management of disturbed patients and the heavy demands of liaison psychiatry and these two areas would need to be further researched.

A case of Cotard's syndrome which resolved following two grand mal seizures is described. This case illustrates how organic factors can be aetiologically significant in psychiatric disease. It also illustrates the usefulness of convulsive therapy, whether prescribed or occurring via nature, in this rare disorder.

An example of folie à deux with an uncommon clinical picture is presented. It concerns two spinster sisters, with no past psychiatric history, who became simultaneously manic while on holiday. The “Principal” was clearly deluded; the “Associate” shared these abnormal beliefs. After recovery and eighteen months later, one became depressed and the other shared her suicidal ideas, but this time the roles of the “Principal” and “Associate” were reversed. The shortcomings of the ICD10 and DSM-IIIR in classifying this syndrome are highlighted.

Expectations for service provision following a disaster are understandably high but difficult to meet. This report considers the case of a patient with pre-morbid anxiety traits and asthma who suffered organic brain damage as a consequence of the Hillsborough Football Stadium disaster, whose care was reactive rather than proactive and resulted in his compulsory admission to a psychiatric hospital. Aftercare arrangements need to be anticipated in advance and should involve early psychiatric assessment of at-risk patients. Medical control of case management following disasters needs further clarification.