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.

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.

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.

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.

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.

A pilot study of the effects of early intervention by a multidisciplinary community team in patients presenting as psychiatric emergencies to an inner London teaching hospital (St. Mary's) is described. Of 22 consecutive emergency referrals, 20 agreed to be formally assessed, 18 were successfully engaged and 16 had assessments of symptoms and social functioning assessed over a four week period. There was significant improvement in clinical symptoms but no important changes in social functioning. The discordance between improvement in social function and symptoms was unexpected and may reflect the unusual social circumstances of life in metropolitan London or be a consequence of the high proportion (55%) of patients seen with personality disorders.

In Ireland, the demographic pressure of greater numbers of elderly people surviving longer with an attendant increase in the prevalence of dementia and depression compounded by the running down of old mental hospitals and the closure of smaller general hospitals has provoked debate on the need for Old Age Psychiatry (Psychogeriatric) Services.

The first Old Age Psychiatry service in the Republic of Ireland started in North Dublin in January 1989. Detailed information on all referrals (173) assessed in the first six months of operation was collected and is presented. The findings are discussed in the context of the stated government policy of caring for the elderly within the community setting.

Wilson's Disease (Hepatolenticular degeneration) is an uncommon disorder of copper metabolism, characterised by excessive copper deposition in the liver, brain and eyes. Psychiatric symptoms were prominent in eight of the twelve patients originally described by Wilson some 88 years ago. Since then a wide range of psychiatric presentations have been documented including behavioural disturbances, affective psychoses, schizophrenia-like psychoses, intellectual deterioration and dementia. Here we describe a patient who presented with a psychiatric disturbance, was treated with neuroleptic medication and subsequently developed Neuroleptic Malignant Syndrome (NMS).

The case of an ex-pugilist who developed a reversible Parkinsonian syndrome in response to ethanol intoxication, is described. The relationship between ethanol abuse and altered function in the nigro-striatal system is examined, and the relationship to boxing encephalopathy is reviewed. The patient described was the third neurological casualty in a family of boxing brothers, and suggestions are made regarding the potential dangers of this sport. The syndrome of alcohol induced Parkinsonism in an ex-pugilist has not previously been described in the literature.

We present a case showing inducement of acute dystonia by clomipramine therapy and discuss the possible explanations. We could find no previous reports of this phenomenon.

Lofepramine at the upper limit of its therapeutic range (210mg/day), was associated with the development of sinus tachycardia with atrial ectopic beats and progression of right bundle branch block to trifascicular block in an 82 year old man with a history of heart disease. As with any antidepressant administered in a high therapeutic dose, caution and regular electrocardiographic monitoring of elderly patients with heart disease receiving lofepramine is recommended.

Two cases of fathers who committed suicide following the revelation that they had sexually abused their own or other children, are described. The importance of being alert to the possibility of suicide and suicidal acts by family members following a disclosure, is emphasised. Improved liaison and co-ordination between agencies working with these families may enable vulnerable cases to be more readily identified and consequently offered appropriate support and treatment.

The revelation that the father in a family has sexually abused his own or other children often precipitates a crisis within the family. The distress suffered by the children themselves and by their mothers is well documented. (Browne and Finkelhor, Hildebrand and Forbes). Goodwin reported suicide attempts in 11 of 201 families, in which sexual abuse had been confirmed. Eight of the attempts were made by daughter-victims. In three of the five cases of mothers who attempted suicide, the abuse was intrafamilial. The impact on father perpetrators, previously a less well researched field, has been receiving more attention of late. Maisch, in a sample of 63 fathers convicted of incest reported that two fathers subsequently committed suicide. Wild has reported on six cases of suicide and three of attempted suicide by perpetrators following disclosure of child sexual abuse. The Cleveland Inquiry Report mentions one father, charged with several sex offences, who committed suicide while awaiting trial. A recent letter to The Guardian newspaper (18th February 1989) by 11 local paediatricians in that area suggests that there are now two such cases of suicide committed by alleged perpetrators.

Levels of immunoglobulins were measured in 32 schizophrenic patients with tardive dyskinesia and 34 schizophrenic patients without tardive dyskinesia. The duration of neuroleptic treatment in years was similar in the two groups. The serum immunoglobulin concentrations (mg%) were found to be significantly different in the two groups; IGA and IGM levels were higher in patients with tardive dyskinesia. The present results may be explained on the basis of dysfunction of the immunological system in tardive dyskinesia.

The Psychoanalytic Deficiency Theory of the Schizophrenias postulates that the symptomatology results from psychical dissolution. Its claim for credibility rests on the range of the clinical observations which it embraces – from the prodromal symptoms to the variety of courses which the schizophrenias follow. The fate of the prodromal symptoms, often indistinguishable from neurotic manifestations, suggest that dissolution and not mental conflict is responsible. The deficiency theory acknowledges the part played by phantasy and conflict in creating the content of delusions. Their form can only be determined by psychical dissolution. The therapeutic approach based on the deficiency theory is to strengthen the residues of the patient's healthy mental life within the context of the psychiatrist-patient and nurse-patient relationship in order to encourage insight into the falsifications and misinterpretations of reality which have contributed to the symptoms.

A service based on the principle that the comprehensive mental health needs of a community can be more efficiently met by supporting the existing primary care services has been developed in the North Aylesbury Vale, Buckinghamshire, England. The Buckingham Project is a home-based mental health service and caters for a rapidly expanding rural community of approximately thirty five thousand people between the ages of 16 and 65 years. Professional support is provided to the services and care already provided by primary health care teams, social agencies and above all, by families. Specially trained nurses work as specialists within the primary care teams in the area. Initial consultation is provided on the day of referral, often in the patient's home. Cost effective management approaches are employed throughout. The emphasis is on early detection of major mental illness and immediate intensive treatment using cognitive/behavioural treatment methods, and targeted low dose medication where necessary. The approach differs from the traditional hospital-based specialist services.