A variety of demographic, psychosocial, intrapersonal and behavioural factors have been shown to influence behavioural change in response to AIDS education. The study investigated perceived risk of HIV acquisition amongst 50 male heterosexual STD clinic attenders and its relationship to knowledge regarding the nature and prevention of transmission of HIV, current sexual practices, relationship difficulties, sexual dysfunction, alcohol abuse and psychiatric morbidity.

The sample demonstrated a good general knowledge about AIDS but there was little evidence of the practice of ‘safer sex’. The overall incidence of psychiatric morbidity was 38%, of problem drinking 52%, of sexual dysfunction 32% and marital/relationship dysfunction 42%. Only 22% felt that their life-style put them at risk of HIV acquisition. It was felt that a narrow emphasis on information in AIDS prevention programmes ignores the powerful effect other factors may have on an individual's motivation to change his behaviour. Evaluation of the cognitions of this at risk group with particular reference to the role of cognitive distortions in perception of risk could provide a means of enhancing the efficacy of future health education campaigns.

The relationship between mental illness and violent behaviour, particularly in schizophrenia, is an important issue both for health care professionals and the general public. Estimates of the prevalence of violence among schizophrenic patients vary according to patient selection, patient setting, and the definition of violence employed. This study investigated the occurrence and characteristics of violence and its clinical correlates among 698 schizophrenic patients who had been treated in an Irish general psychiatric hospital. Violent behaviour occurred in 16% of patients. The vast majority of acts were of a minor nature and serious physical assault was noted in only 1% of cases. Our findings are discussed with reference to the available literature.

This lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.

Hepatitis B surface antigen and antibody to hepatitis B core antigen were measured in 232 long-term psychiatric patients. The aims of the study were to determine the prevalence of infection and to relate it to factors such as age, sex, duration of hospital stay and diagnosis.

There was both an increased rate and increased evidence of past infection amongst the patients tested relative to the general population. There was no statistical significant difference between the antibody positive group compared to the antibody negative group for age, sex and duration of hospital stay, unlike that found in studies of mentally handicapped patients. There was a positive association between the presence of antibody and patient diagnosis. Patients with mental handicap appear to have a predilection for hepatitis B.

Further work needs to be done to elucidate the epidemiology of hepatitis B in psychiatric patients and evaluate the reservoir of infection present.

A review was made of the case notes of all patients admitted to the Psychiatric unit of an East London teaching hospital in 1975, 1980 and 1985. Over the ten year period, the total number of admissions showed little change. In contrast, admissions associated with substance dependence tripled, and those related to substance induced organic mental disorder increased sevenfold. These findings suggest that psychiatrists in acute units should be on the alert to detect cases of psychiatric disorder complicated by substance misuse.

Findings of the influence of hospital training experience in a particular medical speciality on subsequent GP referral patterns to that speciality are outlined. Specialist training appears to sensitise doctors and increase the referral rate to a given speciality. The nature of this sensitisation in medical education is discussed.

To date there has been no study of prescribing habits in a psychiatric hospital in Ireland, as has happened elsewhere.

In a survey over one weekend at St. Brendan's Hospital, the prescription sheets and case notes of all 772 patients were examined.

The principal findings were polypharmacy, the use of benzodiazepines for disturbingly long periods of time, the preponderant prescription of drugs by their proprietary names and the extensive use of neuroleptics for apparently non-psychotic conditions. These results are discussed in the light of other similar surveys.

During the course of imprisonment, whether on remand or when serving a sentence, people sometimes need to be transferred to a psychiatric hospital. In Ireland the only psychiatric hospital a person can be transferred to is the Central Mental Hospital (CMH).

We describe 627 prison transfers to the CMH between 1983 and 1988. The number each year varied from 99 in 1983 to 127 in 1988. The percentage on remand varied from 49% in 1984 to 31% in 1987 and 1986. The average age of sentenced prisoners was 28 years and 35 years in the case of those on remand. The diagnostic categories were as follows: Schizophrenia (31%), Reactive Depression (23%), Personality Disorder (25%), Mania (5%), Drug and Alcohol (8%) and Mental Handicap (4%). The longest average stay in the hospital was seven weeks for Mania and the shortest was three weeks for Reactive Depression. The largest proportion on remand was for Mania (79%) followed by Schizophrenia (58%). We make recommendations about legislation and the role of the catchment area psychiatric hospital.

Sexual dysfunctions are common in S.T.D. (Sexually Transmitted Diseases) Clinic attenders. Marital/relationship dysfunctions frequently follow specific sexual dysfunctions such as erectile, impotence and premature ejaculation. In addition concomitant marital therapy has been shown to enhance treatment for sexual dysfunction. Polypartnerism or multiple or serial sexual partners is also a common feature of S.T.D. clinic attenders. To date, no study has fully evaluated the social, psychological and medical determinants of this behaviour.

The study examined the relationship between sexual dysfunction, marital difficulties and polypartnerism in 50 heterosexual STD clinic attenders. Thirty-one per cent of the sample had pathological scores on the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Forty-two per cent of the sample has pathological scores on the Golombok-Rust Inventory of Marital Satisfaction (GRIMS). There was a significant relationship between sexual dysfunction and marital dysfunction. Polypartnerism was also correlated with sexual and relationship dysfunction. It was felt that by offering treatment for specific sexual dysfunctions identified at STD clinics, marital/relationship difficulties could be averted. Subsequently polypartnerism could be reduced. By altering polypartnerism in this way, an important opportunity to influence vector spread of STD, including HIV infection is afforded.

Twenty-four out of a systematic sample of 95 Mountjoy prisoners were found to have been daily users of opiates. Half of the opiate using prisoners had been abstinent before entering prison for an average of 17.5 months. However, 11 of the total 24 subjects and seven of the 12 abstinent prisoners had not been exposed to any treatment other than detoxification.

This is the first report on the use of the sustained release formulation of adinazolam in the treatment of panic disorder. A six week open lable trial followed by a 1-6 week taper/discontinuation phase was used to assess the safety and efficacy of adinazolam (Deracyn-SR) in the treatment of 10 outpatients with panic disorder and agoraphobia. Adinazolam-SR was well tolerated and produced a rapid improvement in panic and limited symptom attacks, anxiety, phobias, disability, and depressive symptoms. Mean ±S.D. duration of therapeutic action of each dose of this formulation was 12.2±2.3 hours. This is longer than the duration of therapeutic action of other benzodiazepine formulations studied to date for the treatment of panic disorder. Frequency of relapse, rebound and withdrawal symptoms was similar to that found on taper/discontinuation from alprazolam.

The case of a 20-year old female prostitute with a five year history of anorexia nervosa, bulimia nervosa and substance abuse is described. The author was unable to find a previous reference to eating disorders occurring in a prostitute.

Alcohol is a reproductive toxin in animals but little is known about its effects on the production of semen in humans. Nothing is known about the reversibility of any changes. The authors here present a case of alcohol dependence with abnormal semen parameters which improved after two months total abstinence.

One Hundred and two sudden or traumatic deaths of mental handicap inpatients were examined retrospectively over a 28 year period. Data was obtained on each case from medical and nursing case notes and death certificates. Post-mortem results were available for half of the deaths. Cardio-vascular causes accounted for 50% of the total. Sudden deaths of profoundly handicapped patients occurred at a significantly younger age than severely, moderately or mildly handicapped patients. In the latter half of the 28 year period there was an increased incidence of traumatic deaths and sudden deaths due to asphyxia. There was also a significant increase in the mean age of sudden deaths due to epilepsy. Probable explanations for these findings are discussed. In particular, recent accidental traumatic deaths may be related to the process of increased reintegration of patients into the community; a relationship between neuroleptic and anticholingeric medication and asphyxial deaths is proposed.

Thirty two trainees with mental handicap were resettled from two psychiatric hospitals into a centre for people with mental handicap. The progress and problems encountered are described. Recommendations are made for future resettlement programmes.