A significant component of psychiatric practice relates to the management of patients with behavioural disturbance whose aetiology lies in the subtle alteration of brain biochemistry. The major handicap in assessing such patients, both from a clinical and a research point of view has been a lack of suitably sophisticated technology for studying brain function. Despite significant improvements in imaging technique and the development of positron emission tomography we are still lacking tools which assess brain receptor functioning. The neuroendocrine axis provides us with the means of assessing specific neurotransmitters in a safe and relatively inexpensive way. Such an approach is now widely used in research and has considerable potential within a clinical setting.

The fact that classic monoamine neurotransmitters are implicated both in affective disorders and schizophrenia and at the same time control hypothalmic-anterior pituitary function provides the basis for many psychoneuroendocrine investigations. The stimulation of certain central neurotransmitter systems results in the elevation of anterior pituitary hormones. If a pharmacologically selective drug is used, the rise in the anterior pituitary hormone gives some index of the integrity of the neurotransmitter pathway and the sensitivity of its receptor system. This approach is heavily dependent on the development of selective drugs for challenging specific receptor systems. As there are a myriad of potential confounding variables it is essential that there be rigorous control over such factors as gender, age, psychotropic drug exposure, weight loss etc.

The release of growth hormone (GH) from the anterior pituitary is under the control of 2 peptides, namely growth hormone releasing hormone (GHRH) and somatostatin (SS). Noradrenaline acting via the GHRH containing neurones stimulates the release of GH (1,2). We now know that the stimulated release of GH through this mechanism is significantly blunted in patients with major depression (3,4,5). When sone suppression and noradrenergic mediated GH release are both investigated in depressed patients, those subjects who show dexamethasone non-suppression are more likely to demonstrate blunted GH release than those with normal dexamethasone responses (5).

Acetylcholine (ACh) stimulates growth hormone release via the SS method (6). It is now clear that depressed patients show enhanced release when their cholinergic system is challenged with pyridostigmine (7). Overall therefore, depressed patients seem to have a downregulation or under activity of their NA receptors and an up-regulation or over-activity of their ACh receptors.

GH release is also under GABAergic control. In a study of patients with major depression baclofen the GABA-B agonist was used to induce GH release. Baclofen (20 mg) significantly elevated GH levels in all healthy subjects but a blunting of response was seen in those patients with major depressive illness. The finding indicates diminished responsivity of the GABA-B receptor system in depression (7a).

The release of prolactin from the anterior pituitary is under the inhibitory control of dopamine (DA) which acts directly on the lactotrophs of the pituitary. The release of prolactin is stimulated by serotonin (8,9). There is now unequivocal evidence to indicate that 5-HT mediated prolactin release is blunted in major depression (10,11). Such blunting has been demonstrated with a wide variety of probe drugs including 1-tryptophan and fenfluramine. The abnormality is however not entirely specific to depression as patients with obsessive compulsive disorder and sociopathic personality disorder also demonstrate such blunting even in the absence of mood disturbance (12,13).

The first evidence to emerge that central DA receptors might in some way control GH release was demonstrated by the administration of 1-dopa which led to an increase in GH levels (14). GH responses to the DA agonist apomorphine have been reported to be greater in patients with first rank symptoms of schizophrenia, but to be blunted in those patients with significant egative symptoms such as emotional flattening and social withdrawal (15,16).

The very complex neurotransmitter control of such hormones as GH and prolactin provides a window to the biology of neuro-behavioural disturbance. As a tool psychoneuroendocrinology is of relevance not just to the researcher but to the practicing psychiatrist as well.

Objectives: The aim of this study was to determine the views of both individuals attending the mental health services (attendees) and mental health professionals in relation to how attendees and staff should be addressed, how attendees should be described, and how staff should be attired.

Methods: We surveyed 132 attendees of the West Galway Mental Health Services and 97 mental health professionals in relation to how they prefer to be addressed (first name/ title and surname/ no preference) the description of attendees (patient / client / service user / no preference) and the attire of mental health staff (casual / smart / no preference). We also ascertained how mental health professionals believed attendees would view these issues.

Results: Attendees preferred to be described as patients rather than clients or service users by all mental health professionals, with 46-54% of attendees preferring this term “patient” compared to 14-17% preferring the term “client”, 11-13% preferring the term “service user” and 20-25% having no preference (p < 0.001). They preferred to address doctors by their title and surname (61%) but other mental health professionals by their first names (60-69%) (p < 0.001). Attendees had a strong preference for being addressed by their first names by all the mental health professionals (86-91%) (p < 0.001). Doctors preferred to be attired formally (88%), compared to nurses (50%) or other mental health professionals (42%) (p = 0.002). Attendees had no preference in relation to the attire of doctors but preferred other mental health professionals to be attired informally.

Conclusions: The study demonstrates that despite the increased use of several non-medical terms to describe attendees of mental health services; the preferred term of attendees of the psychiatric services in both in-patient and out-patient settings remains ‘patient’. However, this is not universally the case, and the ascertainment of the preference of the attendee at the first encounter with the health professional should be ascertained. We also demonstrated that attendees preferences in relation to both “dress and address” of doctors is significantly different to their preference for nurses or other allied mental health professionals; which may reflect a wish for a less familiar and more formal interaction with doctors.

Objective: To ascertain the outcome of depression and factors associated with outcome over a minimum followup period of 12 months in patients referred to an Old Age Psychiatry Service.

Method: A retrospective study was performed. All depressed patients assessed by the service between January 1989 and December 1990 were followed up. This included patients seen on domiciliary and consultationliaison visits. Follow up data included information on physical, psychological, cognitive and social parameters using standardised scales where appropriate. Outcome of depression was assessed using a six point scale to enable comparison with other studies.

Results: 86 patients with a primary diagnosis of depression were seen in 1989 and 1990. At follow up, 37% were dead. 50% of patients alive at follow up were well and 7% were demented. Patients seen on domiciliary visits had the best outcome, and those with physical illness or cognitive impairment at presentation the worst outcome.

Conclusion: The association between physical status and outcome highlights the need for close monitoring of both physical and mental status of depressed elderly patients.

Tobacco smoking is a contributory factor in the death of 50% of individuals who are regular or heavy smokers (The Office of Tobacco Control Ireland defines a regular smoker as someone who smokes 11-20 per day and a heavy smoker as someone who smokes 21 or more cigarettes per day). The World Health Organisation (WHO) regards tobacco smoking as the leading preventable cause of death worldwide. In Ireland, approximately 750,000 people smoke tobacco regularly (23.5% of the population) with 7,000 Irish people dying annually from smoking-related causes. Although there are no exact figures for prevalence rates of smoking in individuals with mental illness in Ireland, international studies unequivocally state that the prevalence of smoking is significantly higher in those with mental illness, with greater nicotine intake and increased prevalence of nicotine dependence also reported. Furthermore people with mental illness experience greater withdrawal symptoms and have lower cessation rates when attempting to stop smoking compared to the general population.

The Irish State has been party to a collection of international treaties and declarations that directly affect the care of those who suffer from mental disorders. These documents set up what are considered as minimum core standards that outline the standard of care that should be provided as a basic human right. This article reviews the relevant sections of these documents and reflects as to how they have been applied in Ireland. International conventions, which have the status of a treaty, are monitored and interpreted by various commissions and committees. This article draws on the comments of these bodies as to how a state should provide for those with mental illness. Areas such as the rights of children who are mentally ill and those who are detained by the state are examined in detail. Other areas covered are the right to the highest attainable level of mental health care, the right not to be subjected to a clinical trial, equal access to mental health care, and the right to be safeguarded against unjust involuntary detention.

Objectives: This report describes an epidemic outbreak of mass hysteria in secondary school girls in a North Indian village following tetanus toxoid injection. It also attempts to identify the aetiological roles of the immunisation programme and the adverse media reports.

Method: The socio-demographic, clinical, and school environment variables of the 58 symptomatic students were evaluated. Interviews with health staff, parents and school teachers were conducted.

Results: Fifty-eight out of 200 immunised students reported giddiness, headache, vomiting and restlessness. This initiated an exaggerated socio-political response. The majority of the students responded to counselling and reassurance.

Conclusions: This outbreak fulfils the criteria of epidemic or communicable hysteria with mass presentations of unusual behaviour and spread of somatic symptoms without any organic basis. The episode exposed flaws in the immunisation programme and suggests the need to formulate clear guidelines for vaccination, including pre-vaccination counselling.

Three children who experienced hallucinations in two single-parent families are described. The children's symptoms subsided when the families were treated using a family therapy approach. This report highlights the need for mental health professionals to be aware of the possible response of children to parental psychopathology.

Objective: The identification of personality disorder among psychiatric in-patients is important because of the effect on the course and outcome of illness. The introduction of a multiaxial approach to diagnosis, has resulted in a higher than previously reported rate of occurrence of personality disorder in a variety of psychiatric settings. A prevalence of personality disorder of 4.9% is reported in the official statistics for Irish psychiatric hospitals. The aim of this study is to determine the true prevalence of personality disorders in two Irish psychiatric hospitals, one public and one private, using a multiaxial approach to diagnosis.

Methods: The Standardised Assessment of Personality (SAP) is a validated, semistructured, informant based instrument that reliably generates diagnoses of personality disorder irrespective of current mental state. Over a four month period, 78 consecutive, first ever admissions to two hospitals were examined using the SAP.

Results: The prevalence of personality disorder in this population was 26%. There was no significant difference in the rate of personality disorder between the public and private institutions.

Conclusions: The prevalence of personality disorder amongst in-patients in both public and private psychiatric hospitals in Ireland is far higher than previously reported. This highlights the importance of a multiaxial approach to diagnosis in order to establish the true extent of psychiatric morbidity.

Objectives: This study set out to explore if there were measurable personality characteristics specific to parents of people with autism.

Method: Parents of 12 people with a DSM-III-R diagnosis of autism presented for the study. Each of the people with autism were matched where possible with a counterpart without autism but with a lifelong disability on parameters of age, sex and IQ level. Parents of the ‘autism’ and ‘non-autism’ groups were then interviewed in detail using four personality assessment instruments. Scores were tabulated for both mothers and fathers in each group and intergroup comparisons were made.

Results: No significant personality profile difference was identifiable between the two parental groups.

Conclusions: Personality traits specific to parents of people with autism are not identifiable in this study thus casting doubt on the validity of personality phenotypes as measurable heritability factors in autism.

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.

The phenomenon of childbirth-related post-traumatic stress disorder (PTSD) has become more widely recognised in recent years following changes in 1994 to the DSM criteria regarding how a traumatic event was defined. Emerging literature has predominately focused on prevalence rates and risk factors associated with this condition and on the use of debriefing techniques as an attempt to reduce or prevent the development of postnatal PTSD. However, little is known about the efficacy of psychological interventions that have been used to treat PTSD among postnatal women. This review summarises the limited evidence supporting the use of such treatments and discusses the significant challenges in developing and implementing psychological interventions for childbirth-related PTSD.