Objectives: To review recent use of psychosurgery in Britain and Ireland; to outline the indications and contraindications; and to summarise the Irish experience of psychosurgery.

Method: The Geoffrey Knight National Unit for Affective Disorders (GKU), now based at the Maudsley Hospital has performed the largest number of psychosurgical operations in the last 30 years. This paper reviews criteria for referral and outcome of stereotactic subcaudate tractotomy at the GKU. The twenty-one referrals from Ireland to the Unit, resulting in eight operations over the fifteen year period 1981-1995, are considered separately.

Results: The efficacy of stereotactic subcaudate tractotomy is of the order of 30-60% and there is a low incidence of long-term adverse effects. The outcome of the eight Irish patients who underwent psychosurgery compare favourably with the overall outcome figures for the Unit.

Conclusions: Stereotactic subcaudate tractotomy remains a treatment of last resort in the rare cases of severely treatment-resistant affective disorders and obsessive compulsive disorders.

Objectives: This study examines the frequency of childhood sexual abuse and physical abuse in a cohort of opiate addicted patients and looks at clinical correlates in those abused.

Method: Fifty-two consecutive patients attending an out patient drug treatment programme were interviewed using a semi-structured technique. Demographic details, details of schooling, marital status and number of children were recorded. The duration of drug abuse, age of onset of opiate abuse, early life experiences of both child sex abuse and childhood violence and a family history of alcohol abuse were also investigated.

Results: 21.2% of patients gave a history of sex abuse, with 23.1% of patients having a history of exposure to violence as a child. Those exposed to sex abuse had an earlier age of onset of opiate injection. A correlation between parental alcohol abuse and sex abuse and violence was noted.

Conclusions: A history of child sex abuse was associated with earlier onset of opiate abuse in this group of patients. The relatively frequent incidence of abuse and violence in those with opiate abuse must be born in mind when providing treatment. The addressing of issues relating only to addiction leaves earlier traumas continuing to exert an influence on the patient.

Objectives: To provide a methodology for the examination of costs and clinical outcomes in two distinct care settings for psychiatric patients inpatient and day hospitals. The major emphasis is on the relationship between costs and outcomes in the two care regimes.

Method: The study is a retrospective cost-effectiveness analysis. People living in Sector B catchment area in the Mid-Western Health Board who were admitted to inpatient care, or treated as day hospital patients, between June 1st 1994 -February 28th 1995 are eligible for inclusion in the study. Information on resource use and clinical outcome is available for 92 of these patients.

Results: The average weekly cost of care for mentally ill patients in the inpatient setting is over twice the level of the cost of care for people attending the day hospital facility. Pay costs and hotel costs are higher in the inpatient facility. Day hospital care is also more cost-effective than inpatient care, when account is taken of the relationship between cost and clinical outcomes.

Conclusion: The study supports the general literature view of the superiority of community care settings for certain categories of mentally ill people. However, the absence of randomisation in the study, incomplete data, and the retrospective nature of the analysis suggests that caution is needed in the interpretation of the results.

Objectives: To determine the frequency with which abuse, parental separation and bereavement occur on their own or together in children attending child psychiatry services and to assess the relationship between these traumas and attendance and outcome.

Method: A review of all case notes over a 12 month period (n = 435) was conducted and a proforma completed. Information was gathered on clinical presentation, rate of attendance, the presence of sexual abuse, non-sexual abuse including bullying, bereavement and parental separation and a measurement of outcome by subjective assessment was made.

Results: Fifty-nine per cent of the children had experienced at least one of the specified traumas; 13% had experienced two and 2.5% had experienced three. The children who had been abused or bereaved were more likely to require fairly long-term work; those who were adjusting to parental separation required less intervention over time. The children who had been sexually abused had, relatively, the poorest outcome in contrast to those adjusting to bereavement where 87% were considered to have made significant improvement.

Conclusions: Bereavement, abuse and parental separation are common in children referred to the child psychiatric services and these children often require long-term intervention. Increased resources will be required in order to continue to provide adequate intervention and treatment for these children.

Objectives: The aims of the study were to examine: i) whether sex offending in elderly people is a serious problem, ii) whether mental disorder or alcohol abuse occur in association with such behaviour, iii) how such behaviour is managed by the psychiatric service and iv) the outcome of such management.

Method: Referrals of people with sexually offensive behaviour to the North Dublin Psychiatry of Old Age Service from its inception in 1989 to date (1997) were examined. Information collected included: i) mode and reason for referral, ii) demographic, social and medical information, iii) psychiatric diagnosis, iv) management and v) outcome.

Results: Thirteen cases were identified in the eight year period. The sexually offensive behaviours included indecent assault, masturbation in public and lewd remarks. Diagnoses included vascular dementia, frontal lobe dysfunction, Alzheimer's disease, chronic schizophrenia, depression with alcohol abuse and ‘no psychiatric diagnosis’. Two patients had positive syphilis serology detected on dementia screening. Alcohol abuse featured in almost half of the cases. Regarding treatment, five were treated with oral cyproterone acetate and one with benperidol, and all of these had a good response. Three were treated with neuroleptics and also settled. Specific treatment was not indicated in three cases and forensic services were involved in a further three cases.

Conclusions: It is noted that most subjects had an underlying psychiatric diagnosis particularly organic brain damage. Management alleviated the problem in all cases with psychiatric disorder. Cyproterone acetate is clearly useful in management. This review highlights the importance of thorough assessment, diagnosis and management of sexually offensive behaviour in old age.

Objectives: The aim of this study was to provide the first Irish prevalence data on mental illness in an elderly, rural, community dwelling population.

Method: Subjects were identified from four general practitioners' lists. This included GMS patients, private patients and nursing home residents. Six hundred and fifty people aged 65 years or over were interviewed in their own homes using GMS-AGECAT, a standardised diagnostic instrument.

Results: The overall prevalence of mental illness was 14.6%. The prevalence of depression was 9.4%. There was a significantly higher rate among women (13.2%) than men (4.3%). Depression in women was not age related. Of the total sample, 3.7% were classified as organic cases. Of the remaining cases, anxiety disorders occurred most frequently and represented 0.9% of all cases.

Conclusions: Elderly people in rural areas experience similar levels of psychiatric morbidity as those in urban centres.

Objectives: The aims of the audit were to monitor the activities of the liaison clinic over a 12 month period, to establish the number of attenders and non-attenders and to evaluate whether the service was meeting the needs of patients with perinatal disorders.

Method: The Coombe Women's Hospital is one of three maternity hospitals in Dublin and had 6,452 deliveries and 5,273 inpatient gynaecological procedures performed in 1994. The charts of all the patients who were given an appointment for the psychiatric clinic between January 1 and December 31, 1994 were reviewed.

Results: Fifty-six patients attended the clinic over the 12 month period, 38(68%) of whom were new referrals to the service. Twenty-two patients were antenatal, 20 were postnatal and 14 patients were attending the gynaecology department. Seventeen patients (30%) who were referred to the clinic failed to attend for their first appointment. Forty-one (73%) patients had sufficient symptomatology to make an ICD-10 diagnosis. Medication was prescribed for 58% of those who attended. Four patients were referred to their catchment area service for inpatient care: six patients were referred to their catchment area service for further outpatient care as they had psychiatric illnesses which predated their pregnancies.

Conclusions: The number of patients referred to the liaison service with postnatal depression is remarkably less than that anticipated and there is a high rate of defaulting among first attenders. Various recommendations are made to improve the effectiveness of the service.

Psychiatrists throughout Ireland lost a valued and respected colleague when Michael Kelleher died on the 9th August 1998. It is unusual for a doctor and certainly for a psychiatrist to receive widespread tributes in the national as well as the professional press, and these have borne eloquent witness to Michael's qualities as a man and to his achievements as a psychiatrist.

Dr Kelleher's major achievements have been well recorded: they particularly concern his research in Cork on suicide in the latter decades of the 20th century. This interest arose from his work with a post-graduate student, Dr Maura Daly, in the early 1980s. They identified the rising suicide rate, especially amongst the young, and set about understanding the phenomena they carefully observed. Having provided evidence that improved official reporting of suicide was not a sufficient cause of the rising rate, Dr Kelleher moved on to focus on unemployment, the availability of medicines, substance abuse and the rapid changes in Irish society in seeking to explain these disturbing trends. His writing was careful and considered and he maintained a consistently high standard of scholarship. This is clearly evident in his editorial “Youth suicide trends in the Republic of Ireland” for the British Journal of Psychiatry, published posthumously in September 1998. In latter years his voice became familiar in the media when he was always lucid and cautionary, while strongly advocating measures to improve Ireland's mental health.