A coronary event has major psychological, as well as physical, consequences. The recent British Cardiac Society's Working Party Report on Cardiac Rehabilitation acknowledges the importance of comprehensive rehabilitation programmes incorporating a psychological input. Psychological intervention as part of cardiac rehabilitation serves two purposes: to maximise psychosocial recovery, including return to customary activities such as work and sexual relationships, and to facilitate the secondary prevention of coronary heart disease. The latter involves providing behavioural change strategies for a range of lifestyle factors from stress identification and management, through dietary, smoking and physical activity change, to increasing adherence to medication regimes.

Psychological interventions have proven successful in decreasing general morbidity in the year after coronary events and in reducing reinfarction-related mortality. Little is understood about the mechanisms by which psychological interventions may operate. However, a recent seminal study of intensive lifestyle modification in cardiac patients has demonstrated that it is possible to achieve regression of atherosclerosis (although the authors themselves caution that their intensive methods are unlikely to be applicable in most patient settings). More general discussion of the relationship between psychological factors and coronary disease is available. With regard to enhancement of psychosocial recovery, early work documented positive effects of exercise-only programmes on psychosocial functioning.

Objective: A descriptive survey of the characteristics of medical and surgical patients given the diagnosis of adjustment disorder.

Method: 124 case notes of patients with adjustment disorder diagnoses seen over a one year period in a tertiary care hospital were reviewed to describe their characteristics. Patient demographic data, medical illness, hospitalisation details and psychiatric consultation notes were examined.

Results: This diagnosis represented 18.5% of consultation-liaison referrals. The length of hospitalisation for the adjustment disorder patients was more than twice that of general medical admissions. At least one psychosocial stressor was noted in 93% of all patients; in 59% of patients the medical illness was one of the stressors noted. About a third of patients had a past psychiatric history. Only 9% of patients had new courses of antidepressants recommended and in only 2% was inpatient psychiatric admission required. The diagnosis was used especially in patients with serious medical conditions, self-harm, injury and poisoning, and in cases presenting with a mixture of somatic and psychic symptoms.

Conclusions: The results suggest that this is a commonly used diagnosis in the medical consultation setting; it is largely being used in a way consistent with DSM criteria, whilst there were indications that it was also used for a range of problem behaviours that are difficult to classify.

Objective: To assess the effects of relocation on the social behaviour and mental state of a group of 43 long stay psychiatric patients transferred from an old institution to a modern hospital. Method: Each patient was assessed using the MRC Social Behaviour Schedule and the Manchester Scale. Assessments were carried out prior to relocation and at six weeks and six months after transfer. Results: Some deterioration was apparent in the patients' social behaviour at six weeks following relocation but this trend was reversed to definite improvement at six months. There was an overall marked reduction in hostility and violence following relocation. Patients who showed most improvement in terms of social behaviour were the lower functioning group where greater emphasis was placed on promoting basic self care and social skills rather than on occupational therapy. Changes in mental state, following relocation, were minimal but a slight deterioration occurred especially in the area of negative symptoms. Conclusions: Relocations caused no serious adverse effects in the majority of these patients. The improvement observed in certain aspects of behaviour are attributable to the improved physical and psychological milieu of the receiving hospital.

Objective: To estimate the prevalence of anxiety disorders and to explore several potential aetiological factors. Method: Ninety two consecutive patients assessed at a day hospital for patients with probable dementia were interviewed using the CAMDEX schedule. Fifty eight patients gave a sufficiently reliable interview and had a first degree relative in close contact as an informant and were hence included in the study group. The prevalence of RDC generalised anxiety disorder in this group was determined. Type of dementia, severity of dementia and insight were explored as possible aetiological factors. Results: The prevalence of RDC generalised anxiety disorder was 31%. Fifty percent of these patients suffered from anxiety symptoms in the context of RDC major depression. Anxiety disorders were most common in those with mild dementia and in those who retained insight, both showing a trend towards a significant association with anxiety. Conclusions: Anxiety disorders are very common in dementia sufferers particularly in those with mild dementia. Further research is needed in this area, particularly with respect to treatment.

Objective: The purpose of this study was to determine the prevalence of a range of mental disorders in an elderly community dwelling population in Dublin using AGECAT, a reliable and standardised computerised diagnostic system that has been previously validated in community epidemiological surveys.

Methods: A total of 451 individuals over the age of 65 in a GP group practice were interviewed using AGECAT.

Results: Approximately one in five subjects had a mental illness according to AGECAT criteria. The prevalence of depression was 13.1% and did not change appreciably with age. 5.5% of subjects met organic ‘case’ criteria, and the frequency of organic cases increased with age, approximating 15% in the over 80 year age group. Neurotic disorders occurred with very low frequency, representing 1.1% of the subjects tested.

Conclusions: These findings have implications for mentalhealth services planning at a local level, and underscore the utility of AGECAT as a tool for comparative crosscultural epidemiological surveys.

Objective: To describe the clinical characteristics and demographic details of a sample of patients with a principal diagnosis of obsessive compulsive disorder (OCD). Method: A retrospective review of fifty patients with DSM-III-R OCD referred to the Department of Behaviour Therapy at St. Patrick's Hospital, Dublin, Ireland between 1990 and 1991. Standard clinical ratings were made before and after treatment. Ratings used included the Maudsley Obsessive Compulsive Inventory (MOCI), the Fear Questionnaire (FQ), and the Yale-Brown obsessive compulsive score (YBOCS). Results: The male to female ratio was almost equal and the mean duration of illness was 6.1 (SD 11 years). OCD presented in isolation in a minority of cases (14%). A life time history of at least one other DSM-III-R axis I diagnosis, especially depression, was found in 72% of patients. Co-morbid Gilles de la Tourettes syndrome or epilepsy was rare. The majority of patients were on medication prior to presentation (78%). Levels of symptomatology were reduced in 91% of patients who completed treatment. Conclusions: Epidemiological research into the mass aspects of this disorder is required.

Objective: Two day hospitals were established in North Dublin in 1989 to play a key role in the first old age psychiatry service in the Republic of Ireland. The purpose of this study was to identify the characteristics and needs of day hospital attenders, to carry out a preliminary evaluation of the role of the day hospitals in meeting these needs, and make recommendations for future developments. Method: All 237 regular attenders between March 1989 and 1992 were included. Demographic, social, medical and psychiatric data including CAGE questionnaire, Folstein mini-mental state, and Clifton Assessment Procedures for the Elderly survey version, were recorded at initial assessment. Data on duration and outcome of attendance, use of inpatient, general hospital and community care services were collected from a retrospective study of records and subjected to statistical analysis. Results: The average age was 78 years (SD 6yrs); 139 (59%) patients had organic and 98 (41%) had functional psychiatric disorders; 198 (84%) patients had a medical problem. In the functional group, 24 (25%) required acute admission; 70 (71%) patients were managed in the community. Twenty eight (29%) patients required residential care or had died on average 8 months after initial contact. In the group with dementia 104 (75%) had CAPE scores C/D/E at initial assessment, indicating high dependency. Eighty eight (63%) patients were in residential care or dead on average 8 months later. Conclusions: Day hospital treatment enabled elderly patients with functional psychiatric illness to be treated in the community with low usage of beds. It provided only short/medium term care for patients with dementia, who had little support from statutory services. A comprehensive network of services is necessary to support highly dependent patients in the community.

Objective: Physiological and psychological distortions associated with eating are recognised within the syndrome of anorexia nervosa. The purpose of this study was to compare subgroups of restricting and bulimic anorexic patients (AN-R and AN-B) with control subjects, and with themselves after six weeks of refeeding and weight gain, on a series of indices before and after a standard meal. Method: Nineteen consecutively admitted female AN patients completed visual analogue ratings of hunger, satiety, depression, urge to binge, urge to vomit and food craving during the first week and sixth week of hospitalisation. A female control group of seven subjects completed similar ratings for one week. The patient ratings were compared to those of the control subjects at baseline before and after a meal. Further comparisons between the two patient groups were also carried out six weeks after treatment. Results: As expected, AN patients reported significantly higher ratings of depression, urges to vomit, urges to binge and higher satiety levels when compared to controls. Comparisons between the patient subgroups revealed that at baseline AN-B patients had significantly higher urges to vomit that AN-R patients after meals, and reported significantly less satiety both before and after eating. Also, an increase in depression after the meal, at baseline, was reported by both groups although after six weeks higher levels of depression were recorded before rather than after the meal. There was also a significant decrease in food cravings after six weeks compared to baseline for both patient groups.

Conclusions: The findings in this study provide further evidence that clinically significant differences exist between subtypes of patients suffering from anorexia nervosa, and highlight the differential, change in various symptoms during intense hospital treatment.

Objective: To discover whether (as predicted in the literature) loss of contact with caring agencies is related to age, substance dependence, a history of law-breaking, or a diagnosis of schizophrenia.

Method: A consecutive series of 71 homeless people with mental disorders was recruited over a period of 18 months. The subjects were new referrals to psychiatrists working in a primary health care clinic for the homeless. The subjects were then followed up for a further 18 months (maximum follow up time 36 months, minimum follow up time 18 months) to determine duration of contact with Oxford services for helping the homeless (survival time).

Results: Survival analyses indicated that early loss of contact with Oxford services for helping the homeless was strongly predicted by substance (mainly alcohol) dependence in the month before first attendance at the clinic (generalised Wilcoxon 15.8, p<0.001). Homeless people with mental disorders who are also alcohol dependent, were five times more likely to lose contact with caring agencies than homeless people with mental disorders who were not alcohol dependent (hazard ratio 5.05,95% confidence limits 14.9-3.0).

Conclusions: Amongst homeless people with mental disorder, there appears to be an association between substance (mainly alcohol) dependence and loss of contact with caring agencies. This may be because homeless people with a dual diagnosis of mental disorder and substance dependence, tend to be more mobile than those who are not substance dependent.