Knowledge about attention-deficit hyperactivity disorder (ADHD) is rapidly accumulating. Recent advances in diagnosis, genetics, neuroimaging, drug and non-drug treatments are considered, and the results are related to the critical attack on the ADHD diagnosis, which argues it a medicalising social construct, unhelpfully sustaining power relationships. The advances reviewed suggest that, while this attack can be conclusively dismissed as wrong and misleading, the phenomenological definition of ADHD is no longer sufficient for construct validity, though continues to be valuable as a guide for clinicians. The humanising and individualising concerns underlying the attack on the diagnosis could usefully be redirected to improving effective measurement of patient outcomes.

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”.

Preoccupation with weight and shape is very prevalent in the female population and is generally well researched. However, the effects of eating psychopathology on infant growth and child development have not been adequately covered and they merit the attention and interest of clinicians. This present submission, using Medline search, critically reviews the available literature and highlights the importance of clinically addressing these issues. It also makes reference to other areas requiring further research. Fifteen articles are discussed which relate specifically to eating psychopathology and the possible effect on mother-child interactions.

Objective: Eighty one patients admitted following deliberate self-harm were assessed using a semi-structured interview. The aim of the study was to compare clinical and social profiles of the 42 patients who had committed self harm for the first time with those of the 39 who had committed self harm in the past.

Method: The patients were assessed jointly by a psychiatrist and either a community psychiatric nurse or a social worker. A description of past suicidal behaviour, socio demographic information, medical and psychiatric history were recorded. Suicide intent was assessed both from the clinical interview and rated objectively using Pierce's suicide intent scale. Psychiatric diagnoses were made using the ICD 9 classification.

Results: The entire group had experienced difficulties in sustaining relationships. This problem was significantly more widespread in repeaters with increased use of physical violence in their relationship. More patients with a previous history claimed to have death wishes at the time of self harm, and asserted that they would harm themselves again compared with patients without a previous history. Clinical predictions regarding future self harming behaviour were in line with the patient's stated intentions.

Conclusion: The persistent desire to commit self harm and more widespread relational difficulties amongst the patients with a previous history suggests a need for different treatment strategies and outcome measures for the two groups.

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.

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 measure the impact of a six-week Carer Psychoeducation Program (CPP) on factors that influence attitudes towards treatment among carers and relatives of people suffering from schizophrenia. We also examined which specific attitudes to treatment the CPP had the most effect on.

Method: Between 2002 and 2004, all patients and their relatives continued standard care. During this period, we conducted a historically-controlled open trial, in which 64 relatives completed a 17-item adapted version of the Drug Attitudes Inventory (DAI) before and after the CPP.

Results: Attitudes to treatment improved significantly overall (p < 0.001), an improvement most marked in terms of attitudes to health and illness, attitudes towards the physician and attitudes towards the potentially harmful effects of treatment. No statistically significant improvement was found, however, in attitudes to locus of control or the preventative role of treatment.

Conclusion: A CPP specifically improves family attitudes towards treatment. This finding is clinically important because such attitudes influence adherence which, in turn, influences outcome. The fact that certain attitudes are influenced by the CPP, while others are not, may help to explain the mechanism through which patient outcomes improve.

Objective: To explore the nature of the relationship between the Greysteel massacre and the low number of admissions with overdose to the area general hospital in the following week.

Method: Ward records over a ten year period were examined for seasonal and yearly trends for admission with overdose.

Results: In the two year period surrounding the week following the Greysteel massacre there were no similar periods of low admission with overdose.

Conclusion: A direct relationship between the Greysteel massacre and the ensuing dearth of admissions with overdose seems likely.

Childhood behavioural problems and social competence in children of mothers attending a Dublin general practice were studied; they were found to have a prevalence of 30%, and to be associated with maternal depression, and marital disharmony. This relationship is explored, and the possible implications for management in a general practice discussed.

Objectives: This study focused on measuring symptomatology and self-esteem in children admitted to an inpatient child psychiatric unit.

Method: Twenty-six children consecutively admitted to a child psychiatric unit were assessed using the Rutter Parent Interview, the Birleson Depression Scale and the Harter Self Perception Profile for Children. Children were followed up at three and 15 months post-discharge and the same measures administered.

Results: A stay in the unit was linked with a significant reduction in overall symptomatology and this was particularly so for emotional-type symptoms at both follow-up points and for hyperactive-inattentive symptoms at 15-month follow-up. The unit did not appear to be successful at reducing conduct symptoms at either followup. Nor did self-esteem change significantly following an inpatient episode. Children with depressive symptoms especially appeared to benefit both in the short- and longterm and this benefit extended to self-esteem.

Conclusions: When analysing the benefits of an inpatient admission it is crucial to consider outcome and therefore efficacy on a long-term basis. Efficacy needs to take into account longer-term outcomes. The impact of an inpatient episode on a child's psychosocial adjustment will for some children take time. These ‘sleeper effects’ need further study.

This lecture examines issues which have preoccupied psychiatrists in Ireland over nearly 200 years, as recounted in their writings. Some issues: alcoholism, high rates for hospitalised mental illness, and the reported suicide rate, have changed little until the last decade. The valuable contributions of Dr. William Saunders Hallaran, Dr. Connolly Norman and Dr. Dermot Walsh have deserved particular mention.

Drawings can be used as an important tool to measure children's perception and emotions. Using a qualitative design, we asked a group of 24 school children (10 boys and 14 girls) aged 11-12 to draw their impressions of psychiatrists. In the majority of drawings, psychiatrists were portrayed as a friendly or kind figure. The art work was analysed by the coordinator of the Arts Initiative in Mental Health, Niamh O'Connor. Psychiatrists were portrayed positively by this group of young people. This reflects a strong influence of the media on children's perception.

This overview of mental illness services in Ireland, North and South, over recent decades, is a descriptive account. It refers to policies, development and operation of the services, with certain figures relating to hospital admissions, human resources and costs in Northern Ireland and the Republic of Ireland. The paper points to the need for more detailed comparisons, which would require more rigorous, systematic health services research.