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: 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: To determine the characteristics of compulsory admissions by the police and to compare them with compulsory admissions by other means. Method: A retrospective review over one year of the case records of 48 consecutive compulsory admissions after referral by the police was compared with 96 other randomly chosen compulsory referrals over the same period. Results: In both groups a majority had a chronic history of mental illness with frequent prior compulsory hospitalisation. Significant differences were found between the two groups with the police group more often younger, single, unemployed, males. They were also significantly more likely to suffer from schizophrenia and to have had their admission precipitated by behaviour of an assaultive nature, or by property offences, and on admission to spend a shorter period in hospital. Conclusions: It is suggested that at-risk case registers and the use of alternative emergency procedures will serve to lessen the need for police intervention with the mentally ill.

Objective: To discover whether patients who had formerly been prescribed triazolam continued to take psychotropic medication after its withdrawal. Method: 11 general practitioners provided details of the psychotropic medication of their patients who had previously been prescribed triazolam, 12 month after its withdrawal from Britain. Results: 70 of 91 patients (77%) were still taking regular hypnotics twelve months after the drug was withdrawn. Success at withdrawal was linked to lower doses of triazolam but did not depend upon age or sex. Conclusions: The withdrawal of triazolam resulted in a proportion of patients stopping hypnotics that is comparable with other interventions to reduce psychotropic consumption in general practice. Most patients continued to take hypnotics, which suggests that the withdrawal of a drug will usually lead to the substitution of a similar one when one is available.

Objective: The aim of this study was to examine the provision of psychiatric care to inpatients in two Irish general hospitals without psychiatric units and to comment on (a) how this service model compares with previous Irish studies, (b) whether it meets the goals of liaison psychiatry, and (c) the implications for future service planning. Method: Demographic and clinical details relating to all the psychiatric consultations to inpatients (i.e. there was no emergency service to the casualty department) in two general hospitals were collected over a six month period. Results: Although the service was provided on a nonemergency basis the referral rate [1.6% of total admissions], patient characteristics, reasons for referral, diagnoses, and suggested management strategies were very similar to previous Irish studies. Assessment of deliberate self-harm cases was the most common reason for referral [37.9% of 145 referrals]. Notably, there was a high level of diagnostic accuracy from non-psychiatric colleagues in this liaison model. Conclusions: This study, of a service model characterised by an emphasis on liaison, points to efforts on the part of the psychiatrist to improve communication with medical and surgical colleagues as being of primary importance in the development of general hospital psychiatry services.

Multiple personality disorder (MPD) is being diagnosed with increasing frequency, especially in North America. However, soaring estimates of its current prevalence are accompanied by considerable controversy and heated debate. The author presents a number of grounds on which it seems reasonable to base a sceptical view of the validity of this disorder as a naturally occurring diagnostic entity.

Two cases of psychiatric disorder temporally related to the abuse of hallucinogenic amphetamines 3, 4 methylenedi-oxymethamphetamine (MDMA), methylenedioxyamphetamine (MDA) and methylenedioxyethylamphetamine (MDEA) are described, suggesting that a variety of psychiatric morbidity may be precipitated by abuse of these drugs, including paranoid psychosis, mixed affective psychosis and symptoms of obsessive compulsive disorder.

Acute Intermittent Porphyria (AIP) is often accompanied by psychiatric disturbance. Despite routine use of opiate analgesia in the treatment of the acute illness, only one case of dependence is described in the literature. We report a further case where dependence on morphine complicated the assessment and management of a woman with AIP who had been admitted to psychiatric hospital following the death of her child. Clinical implications are discussed.

We describe an adolescent boy who presented with physical symptoms, for which no organic cause could be found. He proved a challenge to medical management and we highlight the reluctance to consider making a diagnosis of conversion disorder. Significant medical contact since infancy, a history of sexual abuse, and current stressors are considered as having contributed to his presentation. We discuss general issues in the management of conversion disorder and consider the risks of neglecting this diagnosis as technological advances are made and sophisticated investigations are relied upon.

Clozapine (Clozaril-Sandoz) is an atypical anti-psychotic drug used for the treatment of resistant schizophrenia. We describe the first fatal outcome as a consequence of neutropenia in the British Isles attributed to the use of clozapine. This death occurred despite proper monitoring by the Clozaril Patient Monitoring Service (CPMS) and full clinical vigilance.

Bipolar affective disorder has a usual age of onset in early adulthood. Adolescent onset occurs in some, prepubertal onset in a few. Early onset affective psychosis in two generations is rarer still and provides powerful evidence for a major genetic effect, especially where adoption removes confounding environmental stresses. We present just such a case in a mother and her daughter.

John Conolly [1774 - 1866] was born at Market Rasen into a collateral branch of the prominent Castletown, Co. Kildare, family. After graduating at Edinburgh in 1821, his efforts in clinical practice, bolstered by indifferent forays into medical journalism, were repeatedly unsuccessful. Thus, at the age of 45, over the course of four years as Resident Superintendent of Hanwell Asylum in Middlesex, he became one of the leading psychiatrists in England. Though his consulting practice blossomed thereafter, it is as the consummate, kindly administrator responsible for the introduction of non-restraint in public asylums in England and Wales that he is remembered today.