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: 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 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.

Therapeutic doses of lofepramine and fluvoxamine were associated with the development of first degree and second degree heart block, respectively, in an 83 year old man with a normal ECG prior to treatment and with no history of cardiovascular disease. Caution is recommended in treating patients with newer generation antidepressants, even in cases where cardiac status appears normal prior to treatment.

Self-injurious behaviour (SIB) is one of the challenging behaviours that is exhibited by people with severe learning disabilities. Various current aetiological theories of SIB have failed to provide a feasible model of care for this complex clinical problem. Recent advances in the understanding of serotonin neurotransmitter function may provide a way forward in the management of SIB. Case histories of two people whose SIB responded to antidepressant medication are described. Possible implication of serotonin neurotransmitter function in the causation of SIB is explored and relevant recent literature is reviewed.

A case of schizophrenia with the belief and behaviour of being a dog has been presented with a review of literature of lycanthropy.

Studies in general medicine and general practice have shown that psychological disorder is frequently undetected and that it may exacerbate the morbidity of physical conditions. The aim of this study was to detect possible psychological disorder in patients with soft tissue neck injury (STNI) attending a 660 bed teaching hospital in Dublin. Using the General Health Questionnaire-30, 100 STNI patients were compared with 100 consecutive other attenders at the Accident and Emergency Department. There was a significantly greater prevalence in the frequency and severity of psychological disorder in the STNI group, who also were more likely to have a history of depression.

A Council of Europe Fellowship was used to visit several centres in England managing and treating child sex abusers in a community setting. Aspects of the services reviewed included organisation, training of staff, assessment of abusers, methods of treatment and resources and facilities available. The application of the English experience to the establishment of treatment programmes in Ireland is discussed.

Objective: The objective of this study was to analyse general practice referrals to psychiatric out-patient clinics and their relation to practice and patient variables.

Method: Retrospective analysis of new episode attendances at out-patient services over a three year period was undertaken. Referring practices were examined for referral rates, single or group practice and the presence of Vocational/Psychiatric training within the practice.

Results: Referral rates were similar to national rates, but were lower than other jurisdictions. There was a tendency for group practices to have lower referral rates.

Conclusions: There was considerable difference between practices in referral rates. These differences were significantly related to GP vocational training.

Objective: To examine the service utilisation of a newly opened psychiatric day centre. We wished to determine if different diagnostic groups had different perspectives of the day centre, and to see if the drop-out rate differed among clients with neurotic or psychotic disorders.

Method: Demographic and diagnostic data was gathered for all clients referred in the first year of operation of the day centre. Those who defaulted from attendance were visited at home and asked to detail reasons for non-attendance. Those who continued to attend 16 months after the centre opened completed a satisfaction survey.

Results: The drop-out rate was high for both clients with neurotic and psychotic disorders. Clients who continued to attend were very positive about the day centre. Both client groups saw the benefits of attendance in social rather than therapeutic terms.

Conclusions: Consumer opinion may have a valuable part to play in overall measure,measurement of service quality, particularly if it includes the opinion of those who no longer use that service.

Objective: An audit of referrals to a child psychiatry clinic is described. The process of asking families to confirm appointments and offering appointments to other families if no confirmation is received was analysed.

Method: Referral information on those refusing appointments offered, whether by declining the offer or by default, was compared with that of families attending first appointments.

Results: Longer waiting times and referral for treatment as opposed to assessment or advice were associated with higher likelihood of appointment refusal

Conclusion: The referral process resulted in a reduction in wasted professional time.

The traitement moral, or so-called moral treatment, of insanity was instituted in Paris in 1794 by Philippe Pinel (1745-1826), and the fetters were removed from patients in May-June 1797 by Jean-Baptiste Pussin (1745-1811), lay governor of the insane at the Hospice de Bicetre, and by Pinel and Pussin at the Salpetriere in 1800; the chains were replaced by straitjackets or in some cases removed completely. His contemporaries looked upon Pinel as physician, but it is as a revolutionary psychiatrist that he is revered today.