Objective: To assess the outcome of treatment, a cross section of women from seven inpatient centres treating alcoholics were interviewed twice: as they entered treatment (n=114) and one year later (n=74) when they returned to the community.

Method: The patients were interviewed as they began treatment and 65% were traced for interviews one year later. Measures of self esteem, emotional health and drinking patterns are presented over time.

Results: Approximately one half of the women were abstinent when interviewed again and improved emotional health was related to abstinence. Of those who continued to drink many reduced their intake. A logistic regression analysis was applied to the data to explain the results. Among the major findings was the ability of therapists to predict subsequent drinking with a high degree of accuracy.

Conclusions: All of the services have abstinence as their goal. This could be challenged since at follow up only half of the women are abstinent. Controlled drinking may well be a valid objective if abstinence fails or could well be a valid objective for some patients.

Objective: The aim of this study was to describe the social, physical, intellectual and psychological characteristics of juvenile delinquents in Dublin.

Method: One hundred consecutive admissions to the St. Michael's Assessment Centre between March 1,1989 and May 31, 1991 were studied. Information was gathered on a wide range of personal, family and social aspects of the delinquents' lives, together with data on their physical, intellectual and psychological profiles.

Results: The majority of subjects came from deprived social and economic backgrounds. 62% of the delinquents were below the 50th percentile for height while 21% were classified as mentally handicapped. The most common psychiatric diagnoses were socialised conduct disorder and mixed disorder of conduct and emotions. Depressive symptoms were endorsed by 12% of the boys and this subgroup tended to engage in more serious offences.

Conclusions: This retrospective study demonstrates the high degree of social, physical, intellectual and psychological disadvantage experienced by Dublin juvenile delinquents and underscores the need for further prospective studies in this poorly understood section of our society.

Various problems can occur when embarking upon training in psychodynamic psychotherapy for the first time. If the difficulties experienced by trainees are not given serious attention by supervisors, trainees may give up at an early stage. This paper looks at the subjective difficulties experienced by three junior trainees in psychiatry in adjusting to such training, and includes comments in reply from one of the organisers of the course which the trainees attended. It is essential for supervisors to address trainees concerns openly, in order to avoid a further decline in the use of this important part of the “therapeutic armamentarium”.

The concerns expressed by Dr. Trigwell and his colleagues are not new. They have been expressed by many critics of psychoanalysis and psychodynamic psychotherapy including within the past decade Frederick Crews and Robert Wilcocks. What gives them a particular relevance and urgency is the fact that they have been articulated by young psychiatrists in training, individuals exposed to the actual practical application of psychoanalytic theory as distinct from theoretical explorations of it. The depressing thing is the reaction of one of the course supervisors. It may well serve only to reinforce their critical view.

The criticisms can be summarised as follows. First, the theories of Freud and his successors were taught on this course at any rate as scientifically established facts rather than as theories or constructs concerning human behaviour, helpful insights in certain instances but not always relevant. These theories and related interpretations were formulated in a way that made it impossible to refute them. They tended to be used in a way that suggested that they explain everything from the most trivial and reflex of thoughts and responses to the most complex and profound.

These criticisms, it might be said, relate to the actual content of psychoanalysis and psychodynamic psychotherapy, to what is being taught. Raymond Tallis has put the same general criticism with somewhat more force, observing that the manner in which psychoanalytic conclusions are drawn from clinical case histories “is reminiscent of how a first year medical student or a hypochondriac, using a few observations to light a gunpowder trail of inference primed with his own preconceptions, might arrive at a wrong diagnosis”.

Patients with frontal lobe meningioma may present to psychiatric services. Clinical diagnostic sensitivity, particularly in the absence of neurological signs, remains central to diagnosis.

Three cases of neuroleptic induced blepharospasm successfully treated by botulinum toxin type A are reported.

A non-alcoholic patient is reported who as a result of self-induced starvation was found to have nystagmus, gait ataxia and severe deficits in recent and remote memory and new learning, with intact immediate recall, abstraction and judgement capabilities. This pattern of cognitive deficit with nystagmus and ataxia suggests the diagnosis of Wernicke-Korsakoff syndrome.

A case of secondary mania subsequent to cerebral hypoxia is presented. The relevant literature is briefly reviewed. The authors suggest that cerebral hypoxia be added to the list of causes of secondary mania.

A patient was admitted with an acute paranoid psychosis. Prior to her illness, she had been using Nicobate patches while still smoking. The relationship between the two are discussed.

Objective: Review of literature on non-compliance with medication in psychiatric patients.

Method: Computer and manual search of English language literature on non-compliance with drugs, psychiatric disorder, and phenomena which may be related, such as readmission and discharge against medical advice.

Results: The literature is discussed and a tentative checklist of risk factors for non-compliance is offered, as is advice on ways in which the problem may be minimised. It is noted that there is an emphasis on major mental disorders in the published literature.

Conclusion: There is no stereotypical defaulter. A high index of suspicion is essential. As far as possible, the patient should be educated to share in the responsibility for treatment, and concerned relatives and others can often play a pivotal role. More research is required on compliance problems in the minor psychiatric disorders. Close liaison with the general practitioner is vital.

At the instigation of William Tuke the York Retreat was built in 1794 by the Society of Friends. From its opening in 1796 until 1845 its management was in the hands of lay administrators, and the moral treatment of insanity which was the creation of George Jepson between 1797 and 1823 became a model of its kind. The great tradition thus established was continued by William's grandson, Samuel Tuke, and Samuel's son Daniel Hack Tuke. Daniel's older brother James is better known to Irish history for his philanthropy during Black '47 which is still warmly embedded in folk memory in the West of Ireland.