We report a case of a male asylum seeker, protesting politically, who stitched his lips together, presenting to a psychiatric service for assessment. We review the literature in this area. Funding of psychiatric services to meet the complex needs of immigrants should be an integral part of service development.

This report describes the case of a 62 year old man with late onset bipolar affective disorder whose mood swings were associated with episodes of thrombocytopenia. The inter-relationships between affective symptoms, the immune system and the hypothalamic pituitary axis are discussed.

The Kleine-Levin Syndrome (KLS) a rare disorder comprising of periodic bouts of hypersomnia and megaphagia is reviewed. The syndrome chiefly affects males. The four accepted female cases in the literature are reviewed and a new female case described. This patient had an IQ in the normal range, unlike the other three female cases where the IQ was measured. She showed an abnormal Cortisol rhythm during both a well and an unwell phase replicating the findings of other workers in some KLS patients. This patient showed normal dexamethasone suppression, a test not previously reported on in KLS. The patient also smoked excessively during the bouts, an occurrence not previously remarked on in this disorder.

Schizophrenia is thought to be the commonest setting in which delusional misidentification syndromes occur. Although schizophrenia is said to occur more commonly in people with learning disabilities, when compared to the general population, reports of delusional misidentification syndromes are extremely limited. The case of a 31 year old woman with mild learning disabilities and first episode of acute schizophrenia is described. She had both Capgras and Fregoli syndromes, and a rare variant of Capgras syndrome in which the misidentification was of a cat, rather than a significant person in her life. Aetiological factors are discussed.

Objectives: The aim of this study was to provide the first Irish prevalence data on mental illness in an elderly, rural, community dwelling population.

Method: Subjects were identified from four general practitioners' lists. This included GMS patients, private patients and nursing home residents. Six hundred and fifty people aged 65 years or over were interviewed in their own homes using GMS-AGECAT, a standardised diagnostic instrument.

Results: The overall prevalence of mental illness was 14.6%. The prevalence of depression was 9.4%. There was a significantly higher rate among women (13.2%) than men (4.3%). Depression in women was not age related. Of the total sample, 3.7% were classified as organic cases. Of the remaining cases, anxiety disorders occurred most frequently and represented 0.9% of all cases.

Conclusions: Elderly people in rural areas experience similar levels of psychiatric morbidity as those in urban centres.

Apart from well known areas of overlap between endocrinology and psychiatry (e.g. studies, in psychiatric disorders, of neurohormones and of the response to manipulations of hypothalamic-pituitary-target gland axis, and analysis of behavioural and psychological disturbances in endocrinological disorders) there is a more intimate intrinsic relationship between the brain and the endocrine system which is less well known or studied. Many of the extracranial endocrine glands have autonomic innervation. Like the pituitary gland which is under direct neural (as well as humoral) diencephalic control, the extracranial endocrine glands are under direct neural control, integrated by the hypothalamus and “head ganglion of the autonomic nervous system”. Yet it is only in the case of the pancreatic islets that this integration has been clearly defined. It is postulated that by this innervation the somatic endocrine glands can respond to homeostatic needs with a rapid initial secretion before the more sustained outpouring of humoral agents typically regulated by blood-borne constituents including pituitary hormones. This is a vast area awaiting further investigation.

A group of 183 longstay psychiatric patients were evaluated regarding their immediate and future discharge potential in order to assist in the future planning of the Mayo Psychiatric Services. Comparisons were made between new longstay patients, who were defined as those who had been in hospital for greater than one but less than five years, and old longstay patients who were in hospital for greater than five years. Age and sex comparisons were also made.

While 28% of those included in the survey were thought fit for immediate discharge, a further 18% were thought to require further active rehabilitation before discharge into the community within one year. The accommodation requirements of those needing continuing inpatient care are discussed. Age and length of time in hospital were found to be associated with discharge potential. Sex difference was not found to be significant. Implications for the development of the service are dicussed on the basis of the findings.

Serotonin toxicity is a potentially life-threatening condition associated with a range of psychotropic medications, co-administration of specific combinations of agents and overdose of certain drugs. It is associated with a wide diversity of clinical signs and symptoms, including cognitive, autonomic and somatic effects, as well as serious complications, including possible death. Diagnosis is often challenging and requires a high index of suspicion. Differential diagnosis includes syndromes such as neuroleptic malignant syndrome. Management depends on the causal agent and urgency of clinical presentation. Treatment may involve discontinuing the causal agent and providing supportive measures, or emergency intervention to preserve vital functions (airway, breathing, circulation), amongst other measures. Further research is needed to clarify the incidence of serotonin toxicity, issues related to differential diagnosis, optimal management of the condition, and treatment of mood problems following serotonin toxicity.

A self-administered questionnaire assessing general knowledge about AIDS, including modes of transmission, methods of prevention and attitudes to the disease, was completed by staff in a psychiatric hospital after an AIDS education seminar. The data were used to assess staff knowledge of and attitudes to AIDS, and to assess the usefulness of the seminar in changing these. Responses to individual questionnaire items were examined for associations with age, sex, job description and attendance at the seminar.

Eighty-six staff members returned questionnaires, a response rate of 39%. The results showed that levels of knowledge concerning AIDS transmission and prevention were high. A significantly greater proportion of seminar attenders were aware that needles should not be recapped after taking blood samples, but when this and other knowledge and attitude responses were corrected to allow for the higher proportion of non-medical staff among the non-attenders, there were no significant differences between attenders and non-attenders.

These results suggest that an omnibus AIDS education seminar may not produce a worthwhile improvement in staff knowledge of or attitudes to AIDS.

We report a case of recurrent parotid gland swelling in a man receiving clozapine. Our aim is to raise awareness of this iatrogenic condition and to review what is known of its pathogenesis and management.

Objective: Dementia is a progressive brain disease. The prevalence of dementia increases with age. Symptomatic pharmacological treatments for dementia are available. Psychological and social interventions can support the patient and their carer. Early recognition and diagnosis of dementia are necessary to access this care and reduce crisis-led intervention. A memory clinic service is ideally placed to commence the assessment and management of dementia. The objective of this paper was to describe the setting up of the memory clinic in Cork University Hospital and review the characteristics of the first 118 patients.

Method: One hundred and eighteen patients were assessed at the memory clinic between July 2004 and Feb 2007. In general the service operated on a two-appointment system. The first appointment was for a comprehensive assessment with investigations. The second appointment was a feedback session with discussion of the diagnosis, prognosis and management plan for the patient and generally their carer. We examined their demographic characteristics, clinical details, psychological test results and results of investigations.

Results: Of the 127 patients referred, 118 (92.9%) attended. Fifteen (12.7%) patients had diagnosis of mild cognitive impairment (MCI), 93 (78.8%) patients were diagnosed with dementia and 5 (4.2%) had diagnosis of depressive disorder with no co-morbid dementia. The dementia type in descending frequency was Alzheimer's disease (50.5%), vascular dementia (34.4%), mixed type dementia (10.8%), Frontal lobe dementia (2.2%) and Lewy body type (2.2%). Of the 93 (78.8%) patients with dementia, 47 (50.5%) had MMSE score ≥20, 29 (31.2%) had MMSE score 11-19 and 17 (18.3%) had score of 0-10. Thirty-three (35.5%) patients were on antidementia medication at the point of referral and a further 16 (17.2%) patients were commenced on these drugs following assessment.

Conclusion: The memory clinic provides a service for the assessment of mild cognitive impairment (MCI) and dementia. It offers diagnosis, an opportunity to receive specific advice regarding dementia management, differentiation between dementia and depression and a resource point for carers and patients.

The Mayan people of Mexico have a radically different concept of illness than that of western countries. In the absence of any formal psychiatric service in their area, the people continue to rely on the interventions of the traditional healers, which include the use of herbal medicines, prayers and magico-religious rituals. A case history of a Mayan patient with a chronic psychotic illness is described, which illustrates the gulf in concepts of mental illness that exists between Western and folk cultures. These cultural differences may have a profound impact on the application of modern psychiatric interventions in developing countries.

Objectives: The establishment of a learning disabilities psychiatric service for people living in north Northamptonshire presented the opportunity to measure the clinical effectiveness of epilepsy care provided by learning disabilities psychiatrists.

Method: Baseline and one year outcome health measurements were made on a group of adults with learning disabilities and epilepsy who received learning disabilities psychiatric care (n = 42), and also on a group of adults with learning disabilities and epilepsy who did not receive care from learning disabilities psychiatry -(n = 12). Comparisons were made between baseline and outcome measurements for those who did, compared to those who did not receive psychiatric care. The comparison group was included as conducting a baseline health assessment may itself improve the quality of healthcare by raising awareness of the issue (in a way that is unconnected to care provided by the psychiatrist).

Results: Learning disabilities psychiatric care was found to effect reduced seizure frequency, with a reduced frequency of drug side-effects and reduced frequency of polypharmacy. The type of the person's seizures was more likely to be determined, medical reviews and appropriate blood test monitoring conducted and active interventions made to improve seizure control and to withdraw unnecessary drugs, if the person was receiving learning disabilities psychiatric care. Almost all of these results were highly statistically significant.

Conclusion: It is important that learning disabilities psychiatric care is available to this group, as it has been demonstrated to effect health gain.